Initiation of Antiretroviral Therapy During Acute HIV-1 Infection Leads to a High Rate of Nonreactive HIV Serology.
Third- and fourth-generation immunoassays (IAs) are widely used in the diagnosis of human immunodeficiency virus (HIV) infection. Antiretroviral therapy (ART) during acute HIV infection (AHI) may impact HIV-specific antibodies, with failure to develop antibody or seroreversion. We report on the ability of diagnostic tests to detect HIV-specific antibodies in Thai participants initiating ART during AHI.



Participants with detectable plasma HIV RNA but nonreactive HIV-specific immunoglobulin G, enrolled in an AHI study, were offered immediate initiation of ART. Participants were tested at initiation and at 12 and 24 weeks following treatment using standard second-, third-, and fourth-generation IAs and Western blot (WB).



Participants (N = 234) initiating ART at a median of 19 days (range, 1-62 days) from HIV exposure demonstrated different frequencies of reactivity prior to and following 24 weeks of ART depending on the IA. Third-generation IA nonreactivity prior to ART was 48%, which decreased to 4% following ART (P < .001). Fourth-generation IA nonreactivity was 18% prior to ART and 17% following ART (P = .720). Negative WB results were observed in 89% and 12% of participants prior to and following 24 weeks of ART, respectively (P < .001). Seroreversion to nonreactivity during ART was observed to at least one of the tests in 20% of participants, with fourth-generation IA demonstrating the highest frequency (11%) of seroreversion.



HIV-specific antibodies may fail to develop and, when detected, may decline when ART is initiated during AHI. Although fourth-generation IA was the most sensitive at detecting AHI prior to ART, third-generation IA was the most sensitive during treatment.



NCT00796146 and NCT00796263.
South East Asia Research Collaboration with Hawaii (SEARCH) Thai Red Cross AIDS Research Centre, Bangkok, Thailand Cooper Human Systems, Cambridge, Massachusetts.
Mark S
MS
de Souza
Henry M. Jackson Foundation for the Advancement of Military Medicine United States Military HIV Research Program, Bethesda, Maryland.
Suteeraporn
S
Pinyakorn
Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, United States Component.
Siriwat
S
Akapirat
Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
Supanit
S
Pattanachaiwit
South East Asia Research Collaboration with Hawaii (SEARCH).
James L K
JL
Fletcher
South East Asia Research Collaboration with Hawaii (SEARCH).
Nitiya
N
Chomchey
South East Asia Research Collaboration with Hawaii (SEARCH) Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
Eugene D
ED
Kroon
HIV Netherlands Australia Thailand Research Collaboration, Bangkok.
Sasiwimol
S
Ubolyam
United States Military HIV Research Program, Bethesda, Maryland Walter Reed Army Institute of Research, Silver Spring, Maryland.
Nelson L
NL
Michael
Henry M. Jackson Foundation for the Advancement of Military Medicine United States Military HIV Research Program, Bethesda, Maryland.
Merlin L
ML
Robb
South East Asia Research Collaboration with Hawaii (SEARCH) Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
Praphan
P
Phanuphak
International Vaccine Institute, Seoul, South Korea.
Jerome H
JH
Kim
South East Asia Research Collaboration with Hawaii (SEARCH) Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
Nittaya
N
Phanuphak
South East Asia Research Collaboration with Hawaii (SEARCH) Henry M. Jackson Foundation for the Advancement of Military Medicine United States Military HIV Research Program, Bethesda, Maryland.
Jintanat
J
Ananworanich
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine; D005260:Female; D015483:HIV Antibodies / Q000097:blood*; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology*; D006679:HIV Seropositivity; D015497:HIV-1 / Q000235:genetics / Q000276:immunology*; D018451:Homosexuality, Male; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D000072339:Sexual and Gender Minorities; D013785:Thailand; D055815:Young Adult
D019380:Anti-HIV Agents; D015483:HIV Antibodies; D007074:Immunoglobulin G; D012367:RNA, Viral
Bangkok; HIV-1; acute HIV infection; immunoassay; seroreversion