title: Extended high viremics: a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection.
abstract: OBJECTIVE
  The present study addressed two questions: what fraction of individuals maintain a sustained high HIV-1 RNA load after the acute HIV-1C infection peak and how long is a high HIV-1 RNA load maintained after acute HIV-1C infection in this subpopulation?
  
  
  METHODS
  Plasma HIV-1 RNA dynamics were studied in 77 participants with primary HIV-1C infection from African cohorts in Gaborone, Botswana, and Durban, South Africa. HIV-infected individuals who maintained mean viral load of at least 100,000 (5.0 log(10)) copies/ml after 100 days postseroconversion (p/s) were termed extended high viremics. Individuals were followed longitudinally for a median [interquartile range (IQR)] of 573 (226-986) days p/s.
  
  
  RESULTS
  The proportion of extended high viremics was 34% [95% confidence interval (CI) 23-44%] during the period 100-300 days p/s and 19% (95% CI 9-29%) over the period of 200-400 days p/s. The median (IQR) duration of HIV-1 RNA load at least 100,000 copies/ml among extended high viremics was 271 (188-340) days p/s. For the subset with average viral load at least 100,000 copies/ml during 200-400 days p/s, the median (IQR) duration was 318 (282-459) days. The extended high viremics had a significantly shorter time to CD4 cell decline to 350 cells/μl (median: 88 vs. 691 days p/s for those not designated as extended high viremics; P < 0.0001, Gehan-Wilcoxon test).
  
  
  CONCLUSIONS
  A high proportion of extended high viremics - individuals maintaining high plasma HIV-1 RNA load after acute infection - have been identified during primary HIV-1 subtype C infection. These extended high viremics likely contribute disproportionately to HIV-1 incidence.
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts 02115, USA.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Novitsky
authors.forename: Thumbi
authors.initials: T
authors.lastname: Ndung'u
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.forename: Hermann
authors.initials: H
authors.lastname: Bussmann
authors.forename: Fundisiwe
authors.initials: F
authors.lastname: Chonco
authors.forename: Joseph
authors.initials: J
authors.lastname: Makhema
authors.forename: Victor
authors.initials: V
authors.lastname: De Gruttola
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Walker
authors.forename: M
authors.initials: M
authors.lastname: Essex
mesh_terms: D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000378:metabolism* / Q000401:mortality / Q000821:virology; D015497:HIV-1 / Q000145:classification*; D006801:Humans; D008297:Male; D012367:RNA, Viral / Q000378:metabolism*; D013019:South Africa / Q000453:epidemiology; D019562:Viral Load
chemical_list: D012367:RNA, Viral