Intermittent low-level viremia in very early primary HIV-1 infection

EW Fiebig, CM Heldebrant, RIF Smith… - JAIDS Journal of …, 2005 - journals.lww.com
EW Fiebig, CM Heldebrant, RIF Smith, AJ Conrad, EL Delwart, MP Busch
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2005journals.lww.com
Serial samples from source plasma donors with confirmed new HIV infection were
investigated for low-level viremia (LLV)(ie,< 100 genome copies [cp]/mL) at time points
preceding the period of steadily rising viremia above 100 cp/mL (ramp-up viremia). Fifteen of
44 plasma donor panels previously studied for the dynamics of HIV viremia during primary
infection contained 70 samples with undetectable HIV-1 RNA by quantitative polymerase
chain reaction (PCR). On retesting with a sensitive qualitative reverse transcriptase PCR …
Abstract
Serial samples from source plasma donors with confirmed new HIV infection were investigated for low-level viremia (LLV)(ie,< 100 genome copies [cp]/mL) at time points preceding the period of steadily rising viremia above 100 cp/mL (ramp-up viremia). Fifteen of 44 plasma donor panels previously studied for the dynamics of HIV viremia during primary infection contained 70 samples with undetectable HIV-1 RNA by quantitative polymerase chain reaction (PCR). On retesting with a sensitive qualitative reverse transcriptase PCR assay (95% detection at 4 cp/mL), we identified LLV in 13 of 15 panels and 23 of 69 retested samples. In 6 panels, a total of 11 samples (1-3 per panel) were consistent with LLV before ramp-up viremia. These samples preceded the first sample with> 100 cp/mL HIV by 9 to 25 days (median= 18 days) and were separated from the latter by at least 1 sample with undetectable viremia by the qualitative PCR assay. We conclude that LLV is not uncommon during the very early period of primary HIV infection preceding ramp-up viremia. It is not known if blood is infectious during this period; however, given the low viral concentrations and transient nature of the observed viremic “blips,” the risk of infectivity can be assumed to be small.
Lippincott Williams & Wilkins