Abstract
T he ability to measure the number of copies of RNA of HIV1 in plasma has allowed the delineation of the dynamics of replication of this retrovirns in the human host.l,2 Utilization of this technology also has allowed more-stringent investigation of the natural history of HIV-1 infection. Cohort studies had defined the median duration of AIDS-free time in infected individuals as varying between 8 and 11 years, 3 although a proportion of infected individuals were recognized to progress more rapidly to severe immunosuppression and opportunistic complications. 4 Later, other infected persons who demonstrated little clinical or immunologic progression were identified. Mathematical models project that approximately 10% of infected individuals will remain AIDS-free for more than 20 years. 3 It has been postulated that this variation in the course of HIV-1 infection is a result of a complex interaction of viral and host characteristics influenced by environmental factors including concurrent infections. Using measurements of plasma HIV-RNA, MACS, a prospective investigation of the natural history of HIV1 infection in men who have sex with men, defined the utility of this assay of viral replication as a marker of prognosis in HIV-1 infection. 5 The study enrolled 4954 AIDS-free men in Baltimore, Pittsburgh, Chicago, and
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