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- Title
Biological and virologic characteristics of primary HIV infection.
- Authors
Schacker, Timothy W.; Hughes, James P.; Shea, Theresa; Coombs, Robert W.; Corey, Lawrence; Schacker, T W; Hughes, J P; Shea, T; Coombs, R W; Corey, L
- Abstract
<bold>Background: </bold>The clinical events surrounding acute HIV-1 infection have been well described, but little is known about whether the virologic course of acute HIV-1 infection influences the subsequent progression of disease.<bold>Objective: </bold>To define the virologic natural history of acute and very early HIV infection.<bold>Design: </bold>Prospective, longitudinal cohort study.<bold>Setting: </bold>University of Washington Research Clinic<bold>Participants: </bold>74 adults enrolled soon after acquisition of HIV (mean, 69 days).<bold>Measurements: </bold>Plasma HIV-1 RNA levels; quantitative cell cultures; CD4 cell counts; and detailed clinical assessments done at study entry, biweekly for 1 month, monthly for 2 months, and quarterly thereafter.<bold>Results: </bold>In the first 30 days after acquisition of HIV, HIV-1 RNA levels varied greatly among participants (range, 27,200 to 1.6 x 10(6) copies per mL of plasma). Levels of HIV-1 RNA decreased by a mean of 6.5% per week for the first 120 days and then increased by a mean of 0.15% per week. CD4 cell counts decreased by a mean of 5.2 cells/mm3 per week for the first 160 days and by a mean of 1.9 cells/mm3 per week thereafter (P < 0.01). Disease progressed faster in participants who sought medical care for their acute seroconversion syndrome (P = 0.01) and those who had high plasma HIV-1 RNA levels 120 to 365 days after acquisition (P < 0.01). Peak levels in the first 120 days were not predictive of disease progression.<bold>Conclusions: </bold>The variability in viral RNA levels associated with acute HIV-1 infection is greater than previously appreciated. Within 120 days of acquisition, plasma HIV RNA levels rapidly decrease to an inflection point, after which they gradually increase. Virus-host interactions soon after acquisition seem to have a major influence on the long-term outcome of HIV-1 disease.
- Subjects
HIV infections
- Publication
Annals of Internal Medicine, 1998, Vol 128, Issue 8, p613
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-128-8-199804150-00001