Actuarial rate of clinical and biological progression in a cohort of 250 HIV‐1‐seropositive subjects

SUMMARY This study was undertaken to define the risk of AIDS in a cohort of 250 HIV‐seropositivc patients identified by their clinical and biological status. All patients were enrolled between October 1985 and March 1988. They were classified according to clinical classes A, asymptomatic ( n = 97); B. lymphadenopathic( n = 123); and C, AIDS‐related complex, ( n = 30). Also as CD4 cell stages 1 (CD4 ± 600/μl; n = 126); 2(CD4 < 600 and ± 300/μ1; n = 83); and 3 (CD4 < 300/μl; n = 41); and serum p24 antigen positive ( n = 48) or negative ( n = 202). All patients were evaluated every 3–6 months, until AIDS development or April 1989: 29 cases of AIDS occurred during the follow‐up period. The risk of AIDS in class C is very high (64% at 2 years) compared with the 3‐year risk of classes A (13%) and B (25%). On the other hand the three CD4 stages have significantly different prognosis (stage 1 6%; stage 2 22%; and stage 3 89%; P < 10 −2 ). Antigen p24 negative and positive patients have also different prognosis (18% and 53%; P < 10 −4 ). Interestingly. p24 antigen conserved its prognostic value in stage 2 (positive 37%. negative 16%) while stages I are at low risk of AIDS and stages 3 at high risk whatever their p24 antigen status. We have also identified the risk of becoming stage 3 and/or p24 antigen positive in p24 antigen negative patients at stages 1 and 2 (respectively, 18% and 47%). This classification should serve to design randomized trials better with experimental drugs with earlier end‐points than AIDS onset.