Viral Loads Within 6 Weeks After Diagnosis of HIV Infection in Early and Later Stages: Observational Study Using National Surveillance Data

Abstract

BackgroundEarly (including acute) HIV infection is associated with viral loads higher than those in later stages.ObjectiveThis study aimed to examine the association between acute infection and viral loads near the time of diagnosis using data reported to the US National HIV Surveillance System.MethodsWe analyzed data on infections diagnosed in 2012-2016 and reported through December 2017. Diagnosis and staging were based on the 2014 US surveillance case definition for HIV infection. We divided early HIV-1 infection (stage 0) into two subcategories. Subcategory 0α: a negative or indeterminate HIV-1 antibody test was ≤60 days after the first confirmed positive HIV-1 test or a negative or indeterminate antibody test or qualitative HIV-1 nucleic acid test (NAT) was ≤180 days before the first positive test, the latter being a NAT or detectable viral load. Subcategory 0β: a negative or indeterminate antibody or qualitative NAT was ≤180 days before the first positive test, the latter being an HIV antibody or antigen/antibody test. We compared median earliest viral loads for each stage and subcategory in each of the first 6 weeks after diagnosis using only the earliest viral load for each individual.ResultsOf 203,392 infections, 56.69% (115,297/203,392) were reported with a quantified earliest viral load within 6 weeks after diagnosis and criteria sufficient to determine the stage at diagnosis. Among 5081 infections at stage 0, the median earliest viral load fell from 694,000 copies/mL in week 1 to 125,022 in week 2 and 43,473 by week 6. Among 30,910 infections in stage 1, the median earliest viral load ranged 15,412-17,495. Among 42,784 infections in stage 2, the median viral load declined from 44,973 in week 1 to 38,497 in week 6. Among 36,522 infections in stage 3 (AIDS), the median viral load dropped from 205,862 in week 1 to 119,000 in week 6. The median earliest viral load in stage 0 subcategory 0α fell from 1,344,590 copies/mL in week 1 to 362,467 in week 2 and 47,320 in week 6, while that in subcategory 0β was 70,114 copies/mL in week 1 and then 32,033 to 44,067 in weeks 2-6. The median viral load in subcategory 0α was higher than that in subcategory 0β in each of the first 6 weeks after diagnosis (P<.001).ConclusionsIn the 1st week after diagnosis, viral loads in early infections are generally several times higher than those in later stages at diagnosis. By the 3rd week, however, most are lower than those in stage 3. High viral loads in early infection are much more common in subcategory 0α than in subcategory 0β, consistent with 0α comprising mostly acute infections and 0β comprising mostly postacute early infections. These findings may inform the prioritization of interventions for prevention.

In vitro replicative fitness of early Transmitted founder HIV-1 variants and sensitivity to Interferon alpha

“…The different stages of HIV-1 infection are classified as primary/acute, asymptomatic/latent, and later/end-stage disease (AIDS). Acute infection is often associated with very high viral load 6 and rapid depletion of CD4 + T cells 4 , while chronic HIV-1 infection is characterized by higher genotypic and phenotypic diversity 7 . Identifying the mechanisms involved in the interaction between the virus and the host during the acute phase of infection can provide a critical opportunity to prevent transmission of HIV infection.…”

Contribution of the classical polymerase chain reaction in the diagnosis of a HIV-1 infected patient in Benin: a case report

“…This may suggest that the patient was at an early stage of infection. Indeed, high VL is associated with an early stage of infection in patients with inconclusive serology [ 5 ]. HIV-1 genetic diversity is a significant concern with respect to diagnostic, and we believe that CAP/CTM v2.0 using two double-labeling hybridization probes and targeting both the gag and LTR regions, amplified and detected correctly our study’s strain.…”

Laboratory Markers and Characteristics of New HIV Infections Among Adolescents in Zambia

“…When the ARV-controlled algorithm was considered, samples with VL ≥ 1,000 copies/ml in which the presence of ARVs was detected were also grouped as old infections. Conversely, samples for which VL ≥ 1,000 copies/ml with absence or undetectable ARVs were then categorized as new infections (5,19). The serological testing algorithm for recent HIV seroconversion (STARHS) estimates the immunological response against the virus on the basis of certain HIV antibody concentration, proportion (BED), isotype or avidity (20, 21).…”

“…Youth are the least likely than any other age group to be aware of their infection. For example, only 42% of adolescents (aged [15][16][17][18][19][20][21][22][23][24] in Zambia knew their HIV status compared to 67% among adults 15-59 years in 2016 (6). Also, population-based survey data from sub-Saharan Africa shows that only 9% of young men 15-19 compared to 13% of of their girls contemporaries had tested and received results for HIV in the last 12 months (7,8).…”