HIV-Infected But Non-Progressing: What Is the Risk for AIDS?

After seroconversion, some patients with HIV infection remain AIDS-free with stable CD4 cell counts and no evidence of disease progression for several years without requiring antiretroviral therapy.¹

A recent study published in The Lancet HIV, attempted to identify factors associated with long-term non-progression (LTNP) in this patient population. The study included data for patients with well-known HIV seroconversion dates from the CASCADE Collaboration-a network of 28 HIV seroconverter cohort studies in Europe, Australia, Canada, and sub-Saharan Africa. The investigators defined non-progression as being HIV-positive without requiring antiretroviral therapy and with stable CD4 cell counts of 500/µL or higher. LTNP was defined as maintaining non-progression status for 10 years after seroconversion.²

This study included 4979 HIV seroconverters who were mostly men (75%). The median time to progression was 2.07 years (95% CI, 1.96 – 2.17). At 10 years post-seroconversion, 283 patients had LTNP, with 202 subsequently progressing (median time to loss of status 2.49 years [2.05- 2.92]). Age, mode of infection, sex, or calendar year of seroconversion had no correlation with loss of LTNP status. In the multivariable analyses, loss of this status was associated with lower CD4 cell counts at 10 years after seroconversion (P<.0001). Higher HIV RNA load at 10 years after seroconversion was independently associated with loss of LTNP status (P=.009) even after excluding CD4 cell counts at 10 years.²

This study shows that most patients with HIV seroconversion will eventually progress to AIDS. Primary care physicians caring for these patients should be aware of this fact and the constant risk of losing non-progression status associated with loss of immunological and clinical control of the HIV infection.

References:

• Poropatich K, Sullivan DJ. Human immunodeficiency virus type 1 long-term non-progressors: the viral, genetic and immunological basis for disease non-progression. J Gen Virol. 2011;92(Pt 2):247-268 doi: 10.1099/vir.0.027102-0.
•  van der Helm JJ, Geskus R, Lodi S, et al on behalf of CASCADE Collaboration in EuroCoord.  Characterisation of long-term non-progression of HIV-1 infection after seroconversion: a cohort study. The Lancet HIV.  2014;1:e41-e48.