Determinants of the Natural History of Human Immunodeficiency Virus Type 1 Infection

Variation in the time to AIDS and duration of survival of human immunodeficiency virus (HIV)-1-infected persons was recognized early in the epidemic. Recent studies have indicated that the rate of viral replication, as manifest by the number of copies of HIV RNA per milliliter of plasma, is a major determinant of outcome in an infected person. The predictive power of the measurement of plasma HIV RNA copy number is enhanced by combining this result with the CD4 lymphocyte number. The determinants of the rate of viral replication are less clearly defined. Recent studies suggest that polymorphism of the chemokine receptors, required for cellular infection, plays a role in regulating the rate of viral replication. The subsequent adaptive evolution of HIV-1 to the host's immune response is a consequence of this dynamic of the virus. Complicating opportunistic infections also appear to enhance HIV-1 replication, while antiviral therapy, in contrast, can and does suppress viral replication.