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Estimating Prognosis in HIV-1 Infection
- John P. Phair, MD
- Northwestern University Medical School, Chicago, IL 60611. Requests for Reprints: John P. Phair, MD, Suite 1106, 680 N. Lake Shore Drive, Chicago IL 60611.
Progression of infection due to the human immunodeficiency virus type 1 (HIV-1) is highly variable. Cohort studies have estimated that the median time, free of serious complications after HIV-1 infection, is 7 to 11 years [1, 2]. These estimates of the incubation period are based on progression to the acquired immuno-deficiency syndrome (AIDS) as defined by the Centers for Disease Control and Prevention in 1987 [3]. With the change in the definition of AIDS [4], the median duration of AIDS-free time will probably decrease [5].
Life-threatening complications of immunosuppression develop after a shorter period of clinical latency in some HIV-1-infected persons [6]. In contrast, other persons show little, if any, loss of immune function or clinical problems during a period of 8 or more years. Differences in the infecting virus [7], the genetic makeup of the host [8], and environmental factors (including concomitant infection [9]) have been suggested as causes of the variation in the duration of clinical latency in persons not receiving antiretroviral therapy. Treatment, with inhibitors of viral reverse transcriptase such as zidovudine (Retrovir) and administration of prophylaxis for pneumonia due to Pneumocystis carinii, has increased (P > 0.05) AIDS-free time in HIV-1- infected persons …
