The progression to AIDS may be significantly related to the level of human immunodeficiency virus type 1 (HIV-1) replication. We have used quantitative cell culture and quantitative DNA and RNA PCR to measure viral load and expression in peripheral blood mononuclear cells obtained cross-sectionally and longitudinally from HIV-1-seropositive homosexual men enrolled in the Multicenter AIDS Cohort Study. Our results indicate that the number of circulating CD4+ T-lymphocytes producing HIV-1 increased as the total number of CD4+ T-cells declined. However, there was no correlation between the number of HIV-1-producing CD4+ cells and the duration of infection. Furthermore, the level of HIV-1 gag RNA increased as the disease progressed and CD4+ cell numbers declined. Subjects who remained asymptomatic with stable CD4+ cell counts, however, maintained a very low level of HIV-1 RNA expression during the entire period of follow-up (38-71 months). In contrast to viral RNA expression, the level of proviral DNA did not change significantly as the disease progressed. However, the level of proviral DNA was significantly higher in AIDS patients than in men who remained asymptomatic. Such increased levels of HIV-1 DNA were detected 34-68 months before the development of AIDS. These results support the role of HIV-1 RNA expression in the development of AIDS.