title: HIV in body fluids during primary HIV infection: implications for pathogenesis, treatment and public health.
abstract: OBJECTIVE
  To describe initial viral dissemination to peripheral tissues and infectious body fluids during human primary HIV infection.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Blood plasma, cerebrospinal fluid (CSF), seminal plasma, cervicovaginal lavage fluid and/or saliva were sampled from 17 individuals with primary HIV infection (range of time from symptoms onset to sampling, 8--70 days) and one individual with early infection (168 days). Subjects' HIV-1 RNA levels in each fluid were compared with levels from antiretroviral-naive controls with established HIV infection. For study subjects, correlations were assessed between HIV-1 RNA levels and time from symptoms onset. Responses to antiretroviral therapy with didanosine + stavudine + nevirapine +/- hydroxyurea were assessed in each compartment.
  
  
  RESULTS
  HIV-1 RNA levels were highest closest to symptoms onset in blood plasma (18 patients) and saliva (11 patients). CSF HIV-1 RNA levels (five patients) appeared lower closer to symptoms onset, although they were higher overall in primary versus established infection. Shedding into seminal plasma (eight patients) and cervicovaginal fluid (two patients) was established at levels observed in chronic infection within 3--5 weeks of symptoms onset. High-level seminal plasma shedding was associated with coinfection with other sexually transmitted pathogens. Virus replication was suppressed in all compartments by antiretroviral therapy.
  
  
  CONCLUSIONS
  Peak level HIV replication is established in blood, oropharyngeal tissues and genital tract, but potentially not in CSF, by the time patients are commonly diagnosed with primary HIV infection. Antiretroviral therapy is unlikely to limit initial virus spread to most tissue compartments, but may control genital tract shedding and central nervous system expansion in primary infection.
authors.affiliation: School of Medicine, University of North Carolina at Chapel Hill, 27599-7030, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Pilcher
authors.forename: D C
authors.initials: DC
authors.lastname: Shugars
authors.forename: S A
authors.initials: SA
authors.lastname: Fiscus
authors.forename: W C
authors.initials: WC
authors.lastname: Miller
authors.forename: P
authors.initials: P
authors.lastname: Menezes
authors.forename: J
authors.initials: J
authors.lastname: Giner
authors.forename: B
authors.initials: B
authors.lastname: Dean
authors.forename: K
authors.initials: K
authors.lastname: Robertson
authors.forename: C E
authors.initials: CE
authors.lastname: Hart
authors.forename: J L
authors.initials: JL
authors.lastname: Lennox
authors.forename: J J
authors.initials: JJ
authors.lastname: Eron
authors.forename: C B
authors.initials: CB
authors.lastname: Hicks
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D001826:Body Fluids / Q000821:virology*; D015331:Cohort Studies; D015658:HIV Infections / Q000188:drug therapy / Q000503:physiopathology / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics / Q000502:physiology*; D006801:Humans; D011634:Public Health; D012367:RNA, Viral / Q000032:analysis / Q000187:drug effects; D014779:Virus Replication / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral