Prospective Study of Acute HIV-1 Infection in Adults in East Africa and Thailand
N Engl J Med May 18, 2016
Merlin L. Robb, M.D., Leigh A. Eller, Ph.D., Hannah Kibuuka, M.B., Ch.B., Kathleen Rono, M.B., Ch.B., Lucas Maganga, M.B., Ch.B., Sorachai Nitayaphan, M.D., Eugene Kroon, M.D., Fred K. Sawe, M.B., Ch.B., Samuel Sinei, M.B., Ch.B., Somchai Sriplienchan, M.D., Linda L. Jagodzinski, Ph.D., Jennifer Malia, Dr.Ph., Mark Manak, Ph.D., Mark S. de Souza, Ph.D., Sodsai Tovanabutra, Ph.D., Eric Sanders-Buell, B.S., Morgane Rolland, Ph.D., Julie Dorsey-Spitz, B.S., Michael A. Eller, Ph.D., Mark Milazzo, B.A., Qun Li, M.Sc., Andrew Lewandowski, Ph.D., Hao Wu, Ph.D., Edith Swann, Ph.D., Robert J. O’Connell, M.D., Sheila Peel, Ph.D., Peter Dawson, Ph.D., Jerome H. Kim, M.D., and Nelson L. Michael, M.D., Ph.D., for the RV 217 Study Team*
Acute human immunodeficiency virus type 1 (HIV-1) infection is a major contributor to transmission of HIV-1. An understanding of acute HIV-1 infection may be important in the development of treatment strategies to eradicate HIV-1 or achieve a functional cure.
We performed twice-weekly qualitative plasma HIV-1 RNA nucleic acid testing in 2276 volunteers who were at high risk for HIV-1 infection. For participants in whom acute HIV-1 infection was detected, clinical observations, quantitative measurements of plasma HIV-1 RNA levels (to assess viremia) and HIV antibodies, and results of immunophenotyping of lymphocytes were obtained twice weekly.
Fifty of 112 volunteers with acute HIV-1 infection had two or more blood samples collected before HIV-1 antibodies were detected. The median peak viremia (6.7 log10 copies per milliliter) occurred 13 days after the first sample showed reactivity on nucleic acid testing. Reactivity on an enzyme immunoassay occurred at a median of 14 days. The nadir of viremia (4.3 log10 copies per milliliter) occurred at a median of 31 days and was nearly equivalent to the viral-load set point, the steady-state viremia that persists durably after resolution of acute viremia (median plasma HIV-1 RNA level, 4.4 log10 copies per milliliter). The peak viremia and downslope were correlated with the viral-load set point. Clinical manifestations of acute HIV-1 infection were most common just before and at the time of peak viremia. A median of one symptom of acute HIV-1 infection was recorded at a median of two study visits, and a median of one sign of acute HIV-1 infection was recorded at a median of three visits.
The viral-load set point occurred at a median of 31 days after the first detection of plasma viremia and correlated with peak viremia. Few symptoms and signs were observed during acute HIV-1 infection, and they were most common before peak viremia. (Funded by the Department of Defense and the National Institute of Allergy and Infectious Diseases.)