Correspondence

Long-Term Survivors and Progression of Human Immunodeficiency Virus Infection

N Engl J Med 1996; 334:1065-1066April 18, 1996

Article

To the Editor:

Much interest has been focused on long-term survivors of human immunodeficiency virus type 1 (HIV-1) infection,1,2 but little information is available about the progression of the disease in these patients. We present the results of a four-year follow-up of 32 patients with hemophilia who fulfilled the following criteria for long-term survival of HIV-1 infection in 1991: documented HIV-1 infection for more than eight years, stable CD4+ T-cell counts greater than 500 cells per cubic millimeter, the absence of symptoms, and no use of antiretroviral therapy.

These 32 long-term survivors represent 14.2 percent of the 225 patients with hemophilia in our initial population,3 a much higher proportion than the 1.8 percent Strathdee et al. found among 325 patients.4 All the patients we studied were men. Their mean age was 23 years (range, 12 to 32); their mean (±SD) absolute CD4+ T-cell count, 648.8±149.1 per cubic millimeter; and the mean proportion of CD4+ cells as a percentage of all lymphocytes, 29.79±8.07 percent. After the four-year follow-up period, 10 patients no longer fulfilled the original criteria used to define the cohort. Two patients had decreases in the absolute CD4+ T-cell count of 15 percent or more per year, one patient's CD4+ count dropped below 200 per cubic millimeter, and seven patients began receiving antiretroviral therapy. The remaining 22 patients had no decrease in the absolute CD4+ T-cell count (mean final value measured, 624.9±121.1 cells per cubic millimeter; percentage of all lymphocytes, 33.05±8.69 percent). Neither age nor the two measures of CD4+ T cells had any influence on the progression of the disease.

These results show that HIV-1 infection progresses in a considerable percentage of long-term survivors, suggesting that long-term survivorship reflects a delay in the progression of the disease rather than the complete absence of progression.

C. Altisent, M.D.
J.B. Montoro, Ph.D.
I. Ruiz, M.D.
Hospital Vall d'Hebron, 08035 Barcelona, Spain

J.I. Lorenzo, M.D.
Hospital La Fe, 46009 Valencia, Spain

4 References

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   Cao Y, Qin L, Zhang L, Safrit J, Ho DD. Virologic and immunologic characterization of long-term survivors of human immunodeficiency virus type 1 infection. N Engl J Med 1995;332:201-208
   Full Text | Web of Science | Medline

2. 2

   Pantaleo G, Menzo S, Vaccarezza M, et al. Studies in subjects with long-term nonprogressive human immunodeficiency virus infection. N Engl J Med 1995;332:209-216
   Full Text | Web of Science | Medline

3. 3

   Montoro JB, Oliveras J, Lorenzo JI, et al. An association between clotting factor concentrates use and mortality in human immunodeficiency virus-infected hemophilic patients. Blood 1995;86:2213-2219
   Web of Science | Medline

4. 4

   Strathdee SA, Craib KJ, Hogg RS, O'Shaughnessy MV, Montaner JS, Schechter MT. Long-term non-progression in HIV infection. Lancet 1995;346:1372-1372
   CrossRef | Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   (2000) Time from HIV-1 seroconversion to AIDS and death before widespread use of highly-active antiretroviral therapy: a collaborative re-analysis. The Lancet 355:9210, 1131-1137
   CrossRef