title: Recent HIV-1 infection: identification of individuals with high viral load setpoint in a voluntary counselling and testing centre in rural Mozambique.
abstract: BACKGROUND
  Identification of recent HIV-infections is important for describing the HIV epidemic and compiling HIV-RNA-setpoint data for future HIV intervention trials. We conducted a study to characterize recent infections, and HIV-RNA-setpoint within the adult population presenting at a voluntary counselling and testing centre (VCT) in southern Mozambique.
  
  
  METHODS
  All adults attending the Manhiça District-Hospital VCT between April and October 2009 were recruited if they had at least one positive rapid HIV-serology test. Patients were screened for recent HIV-1 infection by BED-CEIA HIV-incidence test. Clinical examination, assessment of HIV-RNA and CD4 cell counts were performed at enrollment, 4 and 10 months.
  
  
  RESULTS
  Of the 492 participants included in this study, the prevalence of recent infections as defined by BED-CEIA test, CD4 counts >200 cells/µl and HIV-RNA >400 copies/mL, was 11.58% (57/492; 95% CI 8.89-14.74). Due to heterogeneity in HIV-RNA levels in recently infected patients, individuals were categorized as having "high" HIV-RNA load if their HIV-RNA level was above the median (4.98 log(10) copies/mL) at diagnosis. The "high" HIV-RNA group sustained a significantly higher HIV-viral load at all visits with a median HIV-RNA setpoint of 5.22 log(10) copies/mL (IQR 5.18-5.47) as compared to the median of 4.15 log(10) copies/ml (IQR 3.37-4.43) for the other patients (p = 0.0001).
  
  
  CONCLUSIONS
  The low proportion of recent HIV-infections among HIV-seropositive VCT clients suggests that most of this population attends the VCT at later stages of HIV/AIDS. Characterization of HIV-RNA-setpoint may serve to identify recently infected individuals maintaining HIV viral load>5 log10 copies/mL as candidates for antiretroviral treatment as prevention interventions.
authors.affiliation: Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universtitat de Barcelona), Barcelona, Spain. celia.serna@cresib.cat
authors.forename: Celia
authors.initials: C
authors.lastname: Serna-Bolea
authors.forename: Nilsa
authors.initials: N
authors.lastname: de Deus
authors.forename: Sozinho
authors.initials: S
authors.lastname: Acácio
authors.forename: Jose
authors.initials: J
authors.lastname: Muñoz
authors.forename: Delino
authors.initials: D
authors.lastname: Nhalungo
authors.forename: Emilio
authors.initials: E
authors.lastname: Letang
authors.forename: Pedro
authors.initials: P
authors.lastname: Alonso
authors.forename: Denise
authors.initials: D
authors.lastname: Naniche
mesh_terms: D000328:Adult; D016516:CD4-CD8 Ratio; D003376:Counseling / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000453:epidemiology* / Q000276:immunology / Q000821:virology*; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D012424:Rural Population / Q000706:statistics & numerical data*; D057566:Self Report; D019562:Viral Load / Q000276:immunology*