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. 2009 Apr 1;50(4):403-8.
doi: 10.1097/QAI.0b013e3181945f1e.

Epidemiologic characteristics and natural history of HIV-1 natural viral suppressors

Mohammad M Sajadi  1 , Neil T Constantine, Dean L Mann, Manhattan Charurat, Elham Dadzan, Peter Kadlecik, Robert R Redfield
Affiliations

Epidemiologic characteristics and natural history of HIV-1 natural viral suppressors

Mohammad M Sajadi et al. J Acquir Immune Defic Syndr. .

Abstract

Objective: The objective of this study was to detail the epidemiologic characteristics and natural history of HIV-1 natural viral suppressors (NVSs), a cohort of HIV-1-infected individuals who are able to suppress viral replication to undetectable levels in the absence of therapy.

Design and methods: HIV-1 patients who met the NVS criteria were enrolled into a prospective study. The incidence and prevalence of NVS were calculated by performing a chart review on all patients seen in 1 clinic in a 10-year period. Cumulative probability of progression-free survival was calculated by Kaplan-Meier product limit method.

Results: Forty individuals enrolled in the study. The median year of diagnosis was 1994, and individuals demonstrated a median 6.7 years of HIV-1 viral suppression and CD4 count of 795 cells per microliter. NVS had an incidence of 1.1% [95% confidence interval (CI), 0.0 to 2.1] and prevalence of 1.5% (95% CI, 0.8 to 2.1). Only 1 patient (2.5%) has progressed. Within the first 10 years for follow-up having met the definition of NVS, 95.1% (95% CI 86.5% to 100%) of the NVS continued to control their viral loads to undetectable levels.

Conclusions: The NVS cohort has demonstrated remarkable stability and a low rate of progression over many years. Detailed evaluations of viral-host immune regulatory factors associated with persistent HIV-1 natural viral suppression, and loss of such suppression, has the potential to provide important new insight in HIV pathogenesis and future immune regulatory targeted preventive and therapeutic research.

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Figures

Figure 1
Figure 1
Representative graphs of the different patterns of CD4 slope and viral control seen in the NVS. The Y axis represents CD4 cells/ul and HIV-1 copy number/ml (a value of 0 corresponds to a value below the sensitivity of the assay). As a group the CD4 slope ranged from −66 to + 205 cells/ul per year and CD4 % slope ranged from −3 to +4.44% per year (not shown). Figures A- intermittent detectable viremia in the presence of a rising CD4 slope (+74). Figure B- intermittent detectable viremia in the presence of a stable CD4 slope (−1) Figure C- intermittent detectable viremia in the presence of a falling CD4 slope (−26). Figure D- absence of viremia in the presence of a rising CD4 slope (+75). Figure E- absence of viremia in the presence of a stable CD4 slope (+6). Figure F- absence of viremia in the presence of a falling CD4 slope (−9).
Figure 2
Figure 2
Flow Chart of NVS cases identified for incidence and prevalence at the Baltimore VA using the CCR database.
Figure 3
Figure 3
Kaplan Meir curve for progression demonstrating 95.1% (95% CI 86.5%–100%) progression-free status at 10 years from the time of meeting NVS definition. 184 patient-years of follow-up.
See this image and copyright information in PMC

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