The relation between symptoms, viral load, and viral load set point in primary HIV infection.
OBJECTIVE
To examine the relation between symptoms, initial viral load, and viral load set point in primary HIV infection (PHI).


METHODS
Prospective cohort of patients with preseroconversion or recent seroconversion HIV infection (typically <60 days) in San Francisco.


METHODS
Subjects were questioned about 21 potential PHI symptoms at enrollment and were subsequently followed with viral load measures.


RESULTS
The analysis included 57 subjects with preseroconversion HIV infection and 120 with recent seroconversion. In univariate analysis, most symptoms and the total number of symptoms were each associated with a significantly higher initial viral load. In stepwise multiple linear regression, however, only the number of symptoms was independently associated with a higher initial viral load, with an increase in the initial viral load of 0.08 log10 per additional symptom (P < 0.001). In univariate analysis, more PHI symptoms were associated with a higher viral load set point, but in a multivariable mixed-effects model, this association was accounted for by the initial viral load, which was strongly correlated with viral load set point (R = 0.44, P < 0.001).


CONCLUSIONS
A high initial viral load was associated with more symptoms during PHI. The strong correlation between initial HIV-1 RNA viral load levels and viral load set point suggests that early interactions between the HIV-1 virus and a new host, even before fully developed adaptive immune responses, are important in establishing viral load set point.
Kelley
Colleen F
CF
Department of Medicine, San Francisco General Hospital, University of California at San Francisco, 995 Potrero Avenue, San Francisco, CA 94110, USA.
Barbour
Jason D
JD
Hecht
Frederick M
FM
D000208:Acute Disease; D000328:Adult; D015331:Cohort Studies; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000503:physiopathology* / Q000821:virology; D006679:HIV Seropositivity; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D016014:Linear Models; D008297:Male; D012367:RNA, Viral / Q000097:blood*; D019562:Viral Load
D015483:HIV Antibodies; D012367:RNA, Viral