Absence of prolonged immunosilent infection with human immunodeficiency virus in individuals with high-risk behaviors.
OBJECTIVE
The presence in some individuals of a prolonged phase of infection with human immunodeficiency virus type 1 (HIV-1) before seroconversion remains controversial. This study was undertaken to determine with a sensitive in vitro amplification technique, the polymerase chain reaction (PCR), whether seronegative individuals with high-risk behaviors could harbor HIV-1 sequences in their peripheral blood mononuclear cells (PBMCs) and remain seronegative for more than 6 months.


METHODS
Seronegative individuals who engaged in unprotected anogenital intercourse with HIV-1-infected partners or with more than 10 individuals per year, and seronegative individuals who shared needles with seropositive partners, were recruited prospectively over 18 months. HIV-1 DNA and RNA sequences were detected in PBMCs of these individuals with three PCR assays using SK38/SK39, SK145/SK431, and SK68/SK69. Seronegative but PCR-positive patients were also evaluated with p24 antigen capture assay, radioimmunoprecipitation assay, and Western blot. The latter patients were followed prospectively to reproduce PCR-positive results and monitor serologic responses.


RESULTS
Sixty-one men and 18 women, with an average age of 34.1 +/- 7.6 years, were recruited: 56 were homosexual men, 18 were heterosexual women, and 5 were heterosexual men. Amplification reactions for HIV-1 of 104 PBMC specimens from 79 patients with negative or indeterminate serologies revealed that 4 patients (5.1%) were positive with PCR for HIV-1 DNA and RNA at the time of enrollment. Positive amplification reactions could not be reproduced in prospective samples for one patient. The analysis of a variable human genomic locus in this patient's PBMCs demonstrated that the first PCR-positive sample and following PCR-negative samples originated from different patients, suggesting a specimen mix-up. Two of the three PCR-positive seronegative patients had symptoms suggestive of acute retroviral disease. Sera from all three patients contained p24 antigen. Two patients seroconverted within 1 month whereas one patient could not be followed prospectively.


CONCLUSIONS
Prolonged infection with HIV-1 without seroconversion was not found in our population of patients at very high risk for HIV-1 infection. All PCR-positive patients seroconverted in less than 1 month.
Coutlée
F
F
Centre de Recherche, Hôpital Notre-Dame, Montréal, PQ, Canada.
Olivier
C
C
Cassol
S
S
Voyer
H
H
Kessous-Elbaz
A
A
Saint-Antoine
P
P
He
Y
Y
Fauvel
M
M
D000328:Adult; D005260:Female; D015483:HIV Antibodies; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D008297:Male; D016485:Needle Sharing; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012309:Risk-Taking; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous
D015483:HIV Antibodies