Transient High Levels of Viremia in Patients with Primary Human Immunodeficiency Virus Type 1 Infection

PRIMARY infection with the human immunodeficiency virus type 1 associated with seroconversion is most commonly manifested as an acute illness characterized by fever, myalgia, rash, gastrointestinal symptoms, and at times neurologic complications.123 The period from the onset of illness to seroconversion has ranged from eight days to three months,3,4 with virus detectable in the cerebrospinal fluid, peripheral-blood mononuclear cells, and plasma before the development of an antibody response.3,5678 The acute nature of this clinical syndrome and its prompt resolution in one to two weeks suggest that the kinetics of HIV-1 replication in vivo change rapidly

Eric S. Daar; Tarsem Moudgil; Richard D. Meyer; David D. Ho

2010

Scholarcy highlights

  • PRIMARY infection with the human immunodeficiency virus type 1 associated with seroconversion is most commonly manifested as an acute illness characterized by fever, myalgia, rash, gastrointestinal symptoms, and at times neurologic complications.123 The period from the onset of illness to seroconversion has ranged from eight days to three months,3,4 with virus detectable in the cerebrospinal fluid, peripheral-blood mononuclear cells, and plasma before the development of an antibody response.3,5678 The acute nature of this clinical syndrome and its prompt resolution in one to two weeks suggest that the kinetics of HIV-1 replication in vivo change rapidly
  • Titers of infectious HIV-1 were determined by end-point-dilution culture in sequential samples of plasma and peripheral-blood mononuclear cells from four patients with primary infection, with peak titers of 1000 to 10,000 tissue-culture—infective doses per milliliter of plasma and 100 to 10,000 infective doses per 106 peripheral-blood mononuclear cells
  • P24 core antigenemia and viral isolation have previously been described during primary HIV-1 infection, this report documents the large viral burden during the acute phase of infection
  • Titers of infectious virus in plasma were expressed as tissue-culture—infective doses per milliliter, and titers in PBMC were expressed as TCID per 106 cells
  • The kinetics of the development of the HIV-1—specific antibody response were temporally similar in all four patients, including Patient 1, who underwent repeated plasmapheresis
  • The high levels of infectious HIV-1 found in the PBMC of these patients during seroconversion have been confirmed by quantitative polymerase chain reaction studies that count copies of viral DNA
  • The rapid and spontaneous decline in the viral load suggests an effective immune response in the host that, if understood, may be used to combat acquired immunodeficiency syndrome.

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