Epidemiologic Characteristics and Natural History of HIV-1... : JAIDS Journal of Acquired Immune Deficiency Syndromes (original) (raw)

Epidemiology and Social Science

Sajadi, Mohammad M MD*; Constantine, Neil T PhD*; Mann, Dean L MD†; Charurat, Manhattan PhD*; Dadzan, Elham MD*; Kadlecik, Peter MD‡; Redfield, Robert R MD*

*Institute of Human Virology at the University of Maryland School of Medicine, Baltimore, MD; †Department of Pathology, University of Maryland School of Medicine, Baltimore, MD; and ‡Chase Brexton Health Services, Baltimore, MD.

Received for publication July 28, 2008; accepted November 6, 2008.

M.M.S. supported by a National Institutes of Health K-12 award, grant number 1K12RR023250-01.

Correspondence to: Mohammad M. Sajadi, MD, Institute of Human Virology, 725 West Lombard Street, N548, Baltimore, MD 21201 (e-mail: [email protected]).

JAIDS Journal of Acquired Immune Deficiency Syndromes 50(4):p 403-408, April 2009. | DOI: 10.1097/QAI.0b013e3181945f1e

Abstract

Objective:

The objective of this study was to detail the epidemiologic characteristics and natural history of HIV-1 natural viral suppressors (NVSs), a cohort of HIV-1-infected individuals who are able to suppress viral replication to undetectable levels in the absence of therapy.

Design and Methods:

HIV-1 patients who met the NVS criteria were enrolled into a prospective study. The incidence and prevalence of NVS were calculated by performing a chart review on all patients seen in 1 clinic in a 10-year period. Cumulative probability of progression-free survival was calculated by Kaplan-Meier product limit method.

Results:

Forty individuals enrolled in the study. The median year of diagnosis was 1994, and individuals demonstrated a median 6.7 years of HIV-1 viral suppression and CD4 count of 795 cells per microliter. NVS had an incidence of 1.1% [95% confidence interval (CI), 0.0 to 2.1] and prevalence of 1.5% (95% CI, 0.8 to 2.1). Only 1 patient (2.5%) has progressed. Within the first 10 years for follow-up having met the definition of NVS, 95.1% (95% CI 86.5% to 100%) of the NVS continued to control their viral loads to undetectable levels.

Conclusions:

The NVS cohort has demonstrated remarkable stability and a low rate of progression over many years. Detailed evaluations of viral-host immune regulatory factors associated with persistent HIV-1 natural viral suppression, and loss of such suppression, has the potential to provide important new insight in HIV pathogenesis and future immune regulatory targeted preventive and therapeutic research.