Download 1003 Association Between Number of Acute Retroviral Symptoms

1003 Association Between Number of Acute Retroviral Symptoms and Extended High Viremia by HIV-1 Subtype
Kimberly A. Powers1, Matthew A. Price2, 3, Etienne Karita4, Anatoli Kamali5, William Kilembe6, Susan Allen7, Eric Hunter7, Omu Anzala8, Pat Fast2, Eduard J. Sanders9, 10
Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States, 2International AIDS Vaccine Initiative, New York, NY, United States,
3
Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, United States, 4Project San Francisco, Kigali, Rwanda, 5Medical
Research Council / Uganda Virus Research Institute, Entebbe, Uganda, 6Zambia Emory Research Project, Lusaka and Copperbelt, Zambia, 7Emory University, Atlanta, GA, United
States, 8Kenya AIDS Vaccine Initiative, Nairobi, Kenya, 9Kenya Medical Research Institute, Kilifi, Kenya, 10University of Oxford, Headington, United Kingdom
1
Background: Prompt identification of persons with acute HIV infection, particularly those likely to have high viral loads after acute HIV, presents important
transmission prevention opportunities. In a large study of HIV-1 seroconverters across 9 sites in Africa, we sought to determine whether the number of
signs and symptoms of acute retroviral syndrome (ARS) predicted extended high viremia (mean viral load >= 5 log10 copies/ml 130-330 days after
infection) in HIV-1 subtypes A, C, and D.
Methodology: Adults who acquired HIV-1 infection in a multicenter HIV-1 incidence study were enrolled in a sub-study assessing ARS, immune
progression, and viral load dynamics. Estimated date of infection (EDI) was based on a positive plasma viral load or p24 antigen test prior to seroconversion,
or the mid-point between a negative and positive HIV-1 serologic test. ARS signs and symptoms were assessed at sub-study enrollment, and viral load was
assessed monthly for 3 months post-EDI and quarterly thereafter. “Extended high viremia” was defined as mean pre-ART viral load >=5 log10 copies/ml
130-330 days post-EDI. We used log-binomial regression to examine associations by subtype between the number of ARS symptoms and extended high
viremia, controlling for sex.
Results: Among the 130 volunteers (38%) with pol-derived subtype A infection, extended high viremia prevalence increased linearly with the number of
ARS signs/symptoms; those with 2-7 and >=8 symptoms were 1.9 (95% confidence interval: 1.4, 2.8) and 3.7 (1.8, 7.7) times as likely to have extended
high viremia vs. those with 0-1 symptom (p=0.03 and 0.003, respectively; Figure). Among the 153 subtype-C volunteers (45%), those with 2-7 symptoms
were 2.1 (1.3, 3.4) times as likely to have extended high viremia vs. those with 0-1 symptom (p=0.02; Figure). Among the 59 subtype-D volunteers (17%),
extended high viremia prevalence was similar in those with 2-7 vs. 0-1 symptom (p=0.93). In subtypes C and D, 0% of those with >=8 symptoms had
extended high viremia (Figure); however, measures were imprecise because few subtype-C and D volunteers reported extreme numbers of symptoms.
Conclusions: In this multi-site African cohort, the relationship between number of ARS signs/symptoms and extended high viremia varied appreciably
across subtypes, suggesting potential differences by subtype in pathogenicity, immune response, and the predictive power of number of symptoms in
identifying newly infected persons who likely will have extended high viremia.