Carlos del Rio, MD reviewing Robb ML et al. N Engl J Med 2016 May 18.
In a study of acute HIV-1 infection in East Africa and Thailand, symptoms were common but short-lived, and viral set point was established within 42 days after viremia become detectable and was associated with disease progression.
To elucidate early events in HIV-1 infection that may underlie pathogenesis, investigators recruited volunteers in East Africa and Thailand who were at high risk for HIV-1 infection. Participants underwent twice-weekly HIV-1 RNA testing (NAT) on finger stick samples. Those with positive HIV-1 RNA underwent additional testing and evaluation twice weekly for 4 weeks.
Among 2276 initially HIV-negative participants, 112 had acute HIV-1 infection, of whom 50 had two or more enzyme immunoassay–negative/HIV-1 NAT–reactive samples and a sample before HIV infection, and had not started antiretroviral therapy during acute infection. Among these 50 patients, median time between the last negative sample and the first positive NAT was 4 days; peak viremia (6.7 log10 copies/mL; range, 4.5–8.5) occurred 13 days after first NAT-reactive sample. Median viral load set point (4.4 log10 copies/mL; range, 2.5–6.0) was established within 42 days after first detectable viremia. Peak viremia and downslope of HIV-1 RNA correlated with viral set point and did not have significant geographic variation, but viral set point was 0.8 log10 lower in East Africa than in Thailand. B cells and CD4+ T cells decreased and CD8+ T cells increased during peak viremia, and nadir CD4 T-cell count correlated with CD4 T-cell count at 12 months. CD4 T-cell count at 12 months also correlated inversely with viral set point: 30% of participants reached < 350 CD4 cells/mm3 within a year after infection. Symptoms or signs were common just before and at the time of peak viremia but were short-lived, mild, and nonspecific; fever, headache, and malaise were the most frequently reported symptoms.
Citation(s):
Robb ML et al. Prospective study of acute HIV-1 infection in adults in East Africa and Thailand. N Engl J Med 2016 May 18; [e-pub].
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