Extended high viremics: a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection.

TitleExtended high viremics: a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection.
Publication TypeJournal Article
Year of Publication2011
AuthorsNovitsky V, Ndung'u T, Wang R, Bussmann H, Chonco F, Makhema J, De Gruttola V, Walker BD, Essex M
JournalAIDS
Volume25
Issue12
Pagination1515-22
Date Published07/2011
ISSN1473-5571
KeywordsCD4 Lymphocyte Count, CD4-Positive T-Lymphocytes, Enzyme-Linked Immunosorbent Assay, Female, HIV Infections, HIV-1, Humans, Male, RNA, Viral, South Africa, Viral Load
Abstract

OBJECTIVE: The present study addressed two questions: what fraction of individuals maintain a sustained high HIV-1 RNA load after the acute HIV-1C infection peak and how long is a high HIV-1 RNA load maintained after acute HIV-1C infection in this subpopulation?

DESIGN/METHODS: Plasma HIV-1 RNA dynamics were studied in 77 participants with primary HIV-1C infection from African cohorts in Gaborone, Botswana, and Durban, South Africa. HIV-infected individuals who maintained mean viral load of at least 100,000 (5.0 log(10)) copies/ml after 100 days postseroconversion (p/s) were termed extended high viremics. Individuals were followed longitudinally for a median [interquartile range (IQR)] of 573 (226-986) days p/s.

RESULTS: The proportion of extended high viremics was 34% [95% confidence interval (CI) 23-44%] during the period 100-300 days p/s and 19% (95% CI 9-29%) over the period of 200-400 days p/s. The median (IQR) duration of HIV-1 RNA load at least 100,000 copies/ml among extended high viremics was 271 (188-340) days p/s. For the subset with average viral load at least 100,000 copies/ml during 200-400 days p/s, the median (IQR) duration was 318 (282-459) days. The extended high viremics had a significantly shorter time to CD4 cell decline to 350 cells/μl (median: 88 vs. 691 days p/s for those not designated as extended high viremics; P < 0.0001, Gehan-Wilcoxon test).

CONCLUSION: A high proportion of extended high viremics - individuals maintaining high plasma HIV-1 RNA load after acute infection - have been identified during primary HIV-1 subtype C infection. These extended high viremics likely contribute disproportionately to HIV-1 incidence.

DOI10.1097/QAD.0b013e3283471eb2
Alternate JournalAIDS
PubMed ID21505307
PubMed Central IDPMC3544358
Grant ListR01 AI051164 / AI / NIAID NIH HHS / United States
R01 AI057027 / AI / NIAID NIH HHS / United States
R01 AI057027 / AI / NIAID NIH HHS / United States
R01 AI067073 / AI / NIAID NIH HHS / United States
R01 AI067073 / AI / NIAID NIH HHS / United States
R01 AI51164 / AI / NIAID NIH HHS / United States
R37 AI067073 / AI / NIAID NIH HHS / United States
UM1 AI100663 / AI / NIAID NIH HHS / United States
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