title: Viral load levels measured at set-point have risen over the last decade of the HIV epidemic in the Netherlands.
abstract: BACKGROUND
  HIV-1 RNA plasma concentration at viral set-point is associated not only with disease outcome but also with the transmission dynamics of HIV-1. We investigated whether plasma HIV-1 RNA concentration and CD4 cell count at viral set-point have changed over time in the HIV epidemic in the Netherlands.
  
  
  RESULTS
  We selected 906 therapy-naïve patients with at least one plasma HIV-1 RNA concentration measured 9 to 27 months after estimated seroconversion. Changes in HIV-1 RNA and CD4 cell count at viral set-point over time were analysed using linear regression models. The ATHENA national observational cohort contributed all patients who seroconverted in or after 1996; the Amsterdam Cohort Studies (ACS) contributed seroconverters before 1996. The mean of the first HIV-1 RNA concentration measured 9-27 months after seroconversion was 4.30 log(10) copies/ml (95% CI 4.17-4.42) for seroconverters from 1984 through 1995 (n = 163); 4.27 (4.16-4.37) for seroconverters 1996-2002 (n = 232), and 4.59 (4.52-4.66) for seroconverters 2003-2007 (n = 511). Compared to patients seroconverting between 2003-2007, the adjusted mean HIV-1 RNA concentration at set-point was 0.28 log(10) copies/ml (95% CI 0.16-0.40; p<0.0001) and 0.26 (0.11-0.41; p = 0.0006) lower for those seroconverting between 1996-2002 and 1984-1995, respectively. Results were robust regardless of type of HIV-1 RNA assay, HIV-1 subtype, and interval between measurement and seroconversion. CD4 cell count at viral set-point declined over calendar time at approximately 5 cells/mm(3)/year.
  
  
  CONCLUSIONS
  The HIV-1 RNA plasma concentration at viral set-point has increased over the last decade of the HIV epidemic in the Netherlands. This is accompanied by a decreasing CD4 cell count over the period 1984-2007 and may have implications for both the course of the HIV infection and the epidemic.
authors.affiliation: Stichting HIV Monitoring, Amsterdam, the Netherlands. l.a.gras@amc.uva.nl
authors.forename: Luuk
authors.initials: L
authors.lastname: Gras
authors.forename: Suzanne
authors.initials: S
authors.lastname: Jurriaans
authors.forename: Margreet
authors.initials: M
authors.lastname: Bakker
authors.forename: Ard
authors.initials: A
authors.lastname: van Sighem
authors.forename: Daniela
authors.initials: D
authors.lastname: Bezemer
authors.forename: Christophe
authors.initials: C
authors.lastname: Fraser
authors.forename: Joep
authors.initials: J
authors.lastname: Lange
authors.forename: Jan M
authors.initials: JM
authors.lastname: Prins
authors.forename: Ben
authors.initials: B
authors.lastname: Berkhout
authors.forename: Frank
authors.initials: F
authors.lastname: de Wolf
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology*; D006679:HIV Seropositivity; D015497:HIV-1 / Q000378:metabolism; D006801:Humans; D008297:Male; D009426:Netherlands; D012367:RNA, Viral / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D012367:RNA, Viral