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Predicting Progression to AIDS
- Warner C. Greene, MD, PhD
- Gladstone Institute of Virology and Immunology University of California, San Francisco San Francisco, CA 94141 Acknowledgments: The author thanks Drs. J.M. McCune and J. Kahn for helpful discussions. Requests for Reprints: Warner C. Greene, MD, PhD, Gladstone Institute of Virology and Immunology, P.O. Box 419100, 1310A Potrero Avenue, San Francisco, CA 94110.
Whom to treat, when to treat, and how to treat? These are the difficult questions faced all too frequently by clinicians caring for persons with human immunodeficiency virus (HIV) infection. Now, nearly 15 years into the expanding acquired immunodeficiency syndrome (AIDS) epidemic, we understand that HIV may produce distinctly different temporal patterns of disease progression in different persons [1, 2]. We also appreciate that the current pharmacopoeia of anti-HIV drugs is distinguished as much by its toxicity and its potential to induce drug resistance as it is by its long-term therapeutic benefit [3]. Consequently, many physicians have turned to a more individualized, “patient-specific” approach to treatment.
Given this new approach, both physicians and HIV-infected persons would greatly benefit from a laboratory test capable of predicting the future progression of disease. Such a test would enable the physician to better counsel the patient and optimize the timing of treatment, and it might also be of considerable value in monitoring the patient's response to treatment in the absence of clinical symptoms. As a research tool, such a …
