Long-term HIV-1 infection without immunologic progression

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Objective:To identify and describe a subgroup of men infected with HIV for 10–15 years without immunologic progression, and to evaluate the effect of sexually transmitted diseases (STD) and recreational drug use on delayed HIV disease progression. Design: Inception cohort study. Setting: Municipal STD clinic.Participants:A total of 588 men with well documented dates of HIV seroconversion and 197 HIV-seronegative controls.Main outcome measures:AIDS, CD4+ count, rate of CD4+ cell loss, CD8+ count, β2-microglobulin, complete blood count, p24 antigen and HIV-related symptoms.Results:Of 588 men, 69% had developed AIDS by 14 years after HIV seroconversion (95% confidence interval, 64–73%). Of 539 men with HIV seroconversion dates prior to 1983, 42 men (8%) were healthy long-term HIV-positives (HLP), HIV-infected > 10 years without AIDS and with CD4+ counts >500 × 106/l. When compared with progressors (men with HIV seroconversion prior to 1983 but with AIDS or CD4+ counts <200 × 106/l, HLP had a significantly slower rate of CD4+ decline (6 versus 85x106/l cells/year), and less abnormal immunologic, hematologic and clinical parameters. However, when compared with HIV-uninfected controls, HLP demonstrated lower CD4+ counts and mild hematologic abnormalities. There were no consistent differences between HLP and progressors in prior exposure to recreational drugs or STD.Conclusion:There are individuals with long-term HIV infection who appear clinically and immunologically healthy 10–15 years after HIV seroconversion, with stable CD4+ counts. Lack of exposure to STD or recreational drugs does not appear to explain the delayed course of disease progression in HLP.

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