title: Dynamics of HIV viremia and antibody seroconversion in plasma donors: implications for diagnosis and staging of primary HIV infection.
abstract: OBJECTIVE
  The characterization of primary HIV infection by the analysis of serial plasma samples from newly infected persons using multiple standard viral assays.
  
  
  METHODS
  A retrospective study involving two sets of archived samples from HIV-infected plasma donors. (A) 435 samples from 51 donors detected by anti-HIV enzyme immunoassays donated during 1984-1994; (B) 145 specimens from 44 donors detected by p24 antigen screening donated during 1996-1998.
  
  
  METHODS
  Two US plasma products companies.
  
  
  METHODS
  The timepoints of appearance of HIV-1 markers and viral load concentrations during primary HIV infection.
  
  
  RESULTS
  The pattern of sequential emergence of viral markers in the 'A' panels was highly consistent, allowing the definition and estimation of the duration of six sequential stages. From the 'B' panels, the viral load at p24 antigen seroconversion was estimated by regression analysis at 10 000 copies/ml (95% CI 2000-93 000) and the HIV replication rate at 0.35 log copies/ml/day, corresponding to a doubling time in the preseroconversion phase of 20.5 h (95% CI 18.2-23.4 h). Consequently, an RNA test with 50 copies/ml sensitivity would detect HIV infection approximately 7 days before a p24 antigen test, and 12 days before a sensitive anti-HIV test.
  
  
  CONCLUSIONS
  The sequential emergence of assay reactivity allows the classification of primary HIV-1 infection into distinct laboratory stages, which may facilitate the diagnosis of recent infection and stratification of patients enrolled in clinical trials. Quantitative analysis of preseroconversion replication rates of HIV is useful for projecting the yield and predictive value of assays targeting primary HIV infection.
authors.affiliation: Department of Laboratory Medicine, University of California, San Francisco, CA, USA.
authors.forename: Eberhard W
authors.initials: EW
authors.lastname: Fiebig
authors.forename: David J
authors.initials: DJ
authors.lastname: Wright
authors.forename: Bhupat D
authors.initials: BD
authors.lastname: Rawal
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Garrett
authors.forename: Richard T
authors.initials: RT
authors.lastname: Schumacher
authors.forename: Lorraine
authors.initials: L
authors.lastname: Peddada
authors.forename: Charles
authors.initials: C
authors.lastname: Heldebrant
authors.forename: Richard
authors.initials: R
authors.lastname: Smith
authors.forename: Andrew
authors.initials: A
authors.lastname: Conrad
authors.forename: Steven H
authors.initials: SH
authors.lastname: Kleinman
authors.forename: Michael P
authors.initials: MP
authors.lastname: Busch
mesh_terms: D015415:Biomarkers / Q000097:blood; D001782:Blood Donors; D018450:Disease Progression; D015483:HIV Antibodies / Q000097:blood; D016655:HIV Core Protein p24 / Q000097:blood; D015658:HIV Infections / Q000175:diagnosis* / Q000821:virology; D006679:HIV Seropositivity / Q000097:blood / Q000175:diagnosis / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D007124:Immunoenzyme Techniques; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D019562:Viral Load; D014766:Viremia / Q000175:diagnosis* / Q000821:virology
chemical_list: D015415:Biomarkers; D015483:HIV Antibodies; D016655:HIV Core Protein p24; D012367:RNA, Viral