Plasma and cervical viral loads among Ugandan and Zimbabwean women during acute and early HIV-1 infection

Behavioral and Biomedical Research Department, Family Health International, Research Triangle Park, NC 27709, USA.
AIDS (London, England) (Impact Factor: 5.55). 02/2010; 24(4):573-82. DOI: 10.1097/QAD.0b013e32833433df
Source: PubMed


High levels of HIV-1 viremia exist in peripheral blood during acute and early infection; however, data on HIV-1 viral loads in female genital secretions during this period are sparse.
Prospective cohort of 188 African women with primary HIV-1 infection.
HIV-uninfected and infected women were followed quarterly; we tested serial plasma specimens by HIV PCR to estimate infection dates. We used the Loess procedure to estimate the magnitude and timing of viral setpoints in plasma and cervical secretions and generalized estimating equations (GEE) to identify predictors of plasma and cervical viral setpoints.
We estimated the mean HIV-1 plasma setpoint to be 4.20 log10 HIV-1 RNA copies/ml [95% confidence interval (CI) 4.04-4.35] at 121 days (95% CI 91-137) from infection; an analogous mean cervical viral setpoint was 1.64 log10 HIV-1 RNA copies/swab (95% CI 1.46-1.82) at 174 days (95% CI 145-194) from infection. Cervical loads were significantly higher (0.7-1.1 log10 copies/swab) during acute infection than subsequently. Subtype D infection, pregnancy, breastfeeding, and older age at the time of infection were associated with higher plasma viral setpoint. Subtype C infection, nonviral sexually transmitted infections, having a partner spending nights away from home, recent unprotected sex, and shorter time since infection were associated with higher cervical HIV-1 loads. Hormonal contraception was not associated with either the HIV-1 plasma setpoint or cervical loads during early infection.
Cervical HIV-1 viral loads were highest during acute infection and then declined up to 6 months following infection, when a 'setpoint' was attained. The prognostic value of a cervical 'setpoint' on future transmission risk remains unclear.

Download full-text


Available from: Eric Arts
  • Source
    • "Certain subtypes are now known to be associated with faster HIV disease progression. Subtype D is associated with higher viral load set points [27] and has a higher frequency of syncytium formation and CXCR4 receptor use associated with more rapid decreases in CD4 cell count. Similar rapid CD4 declines are seen in infection with multiple subtypes compared with infection with a single subtype [28, 29]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: At the end of 2011, about half of the 34.0 million [31.4-35.9 million] people living with HIV infection knew their HIV status. With large regional variations, an estimated 0.8 % of all adults aged 15 to 49 years have HIV infection and HIV subtype diversity is increasing. Although HIV incidence has declined in 39 countries, it is stable or increasing in others. HIV prevalence continues to rise as antiretroviral treatment scale-up results in fewer HIV-related deaths while new infections continue to occur. Increased treatment uptake is likely reducing HIV transmission in countries with large mortality declines. Key populations, including sex workers, men who have sex with men, transgender people, people who inject drugs and young women in high prevalence settings require effective prevention programs urgently. Correcting mismatches in resource allocation and reducing community viral load will accelerate incidence declines and affect future epidemic trends, if concerted action is taken now.
    Full-text · Article · Apr 2013 · Current HIV/AIDS Reports
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Acute HIV infection (AHI), the earliest period after HIV acquisition, is only a few weeks in duration. In this brief period, the concentration of HIV in blood and genital secretions is extremely high, increasing the probability of HIV transmission. Although a substantial role of AHI in the sexual transmission of HIV is biologically plausible, the significance of AHI in the epidemiological spread of HIV remains uncertain. AHI is diagnosed by detecting viral RNA or antigen in the blood of persons who are HIV seronegative. Depending on the setting, persons with AHI represent between 1 and 10% of persons with newly diagnosed HIV infection. The high concentration of virus during AHI leads to increased infectiousness, possibly as much as 26 times greater than during chronic infection. In mathematical models, the estimated proportion of transmission attributed to AHI has varied considerably, depending on model structure, model parameters, and the population. Key determinants include the stage of the HIV epidemic and the sexual risk profile of the population. Despite its brief duration, AHI plays a disproportionate role in the sexual transmission of HIV infection. Detection of persons with AHI may provide an important opportunity for transmission prevention.
    Full-text · Article · Jul 2010 · Current opinion in HIV and AIDS
  • [Show abstract] [Hide abstract]
    ABSTRACT: This review will discuss the role of antiretroviral therapy to treat primary HIV infection (PHI) as a strategy to prevent onward viral transmission. Novel technology has greatly enhanced the appreciation of the characteristics of recently transmitted HIV-1 variants. Recent primate data demonstrate marked enhanced infectiousness of viral variants isolated from acutely infected macaques compared with viruses isolated from animals in the chronic phase of disease. These data are supported by phylogenetic analyses of recently transmitted cases in humans, implying that individuals with PHI may contribute disproportionately to onward transmission at a population level. In the absence of randomized clinical trial data supporting individual benefit of antiretroviral therapy, targeting and treating individuals with PHI as a public health intervention strategy represent a paradigm shift from current treatment strategies based around proven individual benefit alone. However, there is increasing evidence that PHI contributes disproportionately to viral transmission at a population level and failure to incorporate the potential role PHI plays, particularly in focused epidemics, maybe a naïve omission of many of the current mathematical models evaluating the impact of universal test and treat on population-level HIV incidence.
    No preview · Article · Jul 2010 · Current opinion in HIV and AIDS
Show more