title: Despite being highly diverse, immunovirological status strongly correlates with clinical symptoms during primary HIV-1 infection: a cross-sectional study based on 674 patients enrolled in the ANRS CO 06 PRIMO cohort.
abstract: OBJECTIVE
  To analyse immunovirological status during primary HIV-1 infection (PHI) according to contemporary clinical status and time since infection.
  
  
  METHODS
  Plasma HIV-RNA and peripheral blood mononuclear cell (PBMC) HIV-DNA levels and CD4 cell counts were determined at enrolment in the ANRS PRIMO cohort. Time since infection was estimated based on both the number of antibodies on western blot at enrolment (0-1, 2-4 or > or =5 specific antibodies) and the estimated interval between infection and enrolment based on clinical and epidemiological features. Patients were classified according to the presence or absence of clinical symptoms at enrolment.
  
  
  RESULTS
  Between 1996 and 2006, 674 patients were enrolled an estimated median of 47 days after infection. Median marker values were as follows: HIV-RNA 5.10 log(10) copies/mL (range <1.70-8.33); HIV-DNA 3.30 log(10) copies/10(6) PBMCs (<1.84-4.93); and 506 CD4 cells/mm(3) (40-1542). Median HIV-RNA and PBMC HIV-DNA levels were significantly higher in patients with 0 or 1 specific antibody (n = 71) than in patients with 2-4 (n = 228) or > or =5 antibodies (n = 375). Symptomatic patients had significantly higher HIV-RNA and PBMC HIV-DNA levels and lower CD4 cell counts. However, 10% of symptomatic patients recruited shortly after infection had favourable immunovirological status.
  
  
  CONCLUSIONS
  Plasma HIV-RNA, PBMC HIV-DNA and CD4 cell count values were highly diverse and correlated strongly with clinical status during PHI. Early diagnosis was not always associated with severe PHI. Combining PBMC HIV-DNA with HIV-RNA, CD4 cell count and clinical symptoms would have allowed identification of 179 patients (26.5%) at high risk of rapid disease progression who did not meet current guidelines for early treatment initiation.
authors.affiliation: Université Paris Descartes, EA MRT 3620, Virology Department, AP-HP, Centre Hospitalier Universitaire Necker-Enfants Malades, 149 Rue de Sèvres, 75015 Paris, France. jade.ghosn@bct.aphp.fr
authors.forename: Jade
authors.initials: J
authors.lastname: Ghosn
authors.forename: Christiane
authors.initials: C
authors.lastname: Deveau
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Chaix
authors.forename: Cécile
authors.initials: C
authors.lastname: Goujard
authors.forename: Julie
authors.initials: J
authors.lastname: Galimand
authors.forename: Yasmine
authors.initials: Y
authors.lastname: Zitoun
authors.forename: Thierry
authors.initials: T
authors.lastname: Allègre
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Delfraissy
authors.forename: Laurence
authors.initials: L
authors.lastname: Meyer
authors.forename: Christine
authors.initials: C
authors.lastname: Rouzioux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000097:blood; D005260:Female; D015483:HIV Antibodies / Q000097:blood*; D015658:HIV Infections / Q000276:immunology* / Q000473:pathology* / Q000821:virology; D015497:HIV-1 / Q000276:immunology* / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D015483:HIV Antibodies; D012367:RNA, Viral