Differences in HIV RNA levels before the initiation of antiretroviral therapy among 1864 individuals with known HIV-1 seroconversion dates.
OBJECTIVE
To assess the effects of sex, risk group, age at and year of seroconversion (SC), and presentation during acute infection on HIV RNA trends before antiretroviral therapy (ART) initiation.


METHODS
Multiple HIV RNA measurements from 1864 individuals with reliably estimated dates of SC, aged >/= 15 years at SC were studied using random effects models. Models were adjusted for selective HIV RNA data truncation due to ART initiation or AIDS development and for HIV RNA quantification assay.


RESULTS
HIV RNA levels declined precipitously during the first 10 months after SC followed by a slow increase. Women infected heterosexually and through injecting drug use, had an average 34% [95% confidence interval (CI), 2.3-56%] and 46% (95% CI, 17-66%) lower HIV RNA load respectively, compared to men in the same risk group. Among men, those infected heterosexually and by injecting drug use had on average 56% (95% CI, 36-69%) lower HIV RNA levels than homosexual men. Older subjects tended to have higher viral levels. There was no evidence that differences by sex, risk or age group diminished over time, but follow-up was mostly before CD4 cell count had fallen below 200 x 10 cells/l.


CONCLUSIONS
HIV RNA levels at the same stage of HIV-1 infection differ significantly by sex, risk group and age at SC. Given the lack of evidence of a survival difference by sex or risk group prior to initiation of effective therapy, further research on differential effects of virus load on treatment-free disease progression is needed, before a conclusion about considering these factors for ART initiation is drawn.
Department of Hygiene and Epidemiology, Athens Univerity Medical School, Greece.
Giota
G
Touloumi
Nikos
N
Pantazis
Abdel G
AG
Babiker
Sarah A
SA
Walker
Olga
O
Katsarou
Anastasia
A
Karafoulidou
Angelos
A
Hatzakis
Kholoud
K
Porter
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000635:transmission; D006679:HIV Seropositivity / Q000188:drug therapy / Q000276:immunology / Q000635:transmission; D015497:HIV-1; D006801:Humans; D008297:Male; D012367:RNA, Viral / Q000032:analysis*; D012307:Risk Factors; D012737:Sex Factors; D019562:Viral Load
D044966:Anti-Retroviral Agents; D012367:RNA, Viral