AEGiS-11IAC: Characteristics and identification of early HIV seroconverters.

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

Characteristics and identification of early HIV seroconverters.

Int Conf AIDS 1996 Jul 7-12; 11:27 (abstract no. LB.B.6023)
Celum C, Buchbinder S, Donnell D, Douglas J, Mayer K, Marmor M, Koblin B, Flores J, Self S, Sheppard HW; Pacific Medical Centre, Seattle, WA. Fax: (206) 621-4582. E-mail: ccelum@u.washington.edu.

OBJECTIVES: Pathogenesis and treatment studies on acute HIV infection usually enroll symptomatic seroconverters. To evaluate whether referral-based populations may differ from prospectively-identified unselected seroconverters, we compared seroconverters who sought medical care to those who did not seek care by viral load and CD4 counts. We also evaluated attempts to identify newly-infected participants between their scheduled semi-annual visits.

METHODS: Prospectively-ascertained HIVNET seroconverters who had sought care since their last HIV negative test were compared for the time since estimated seroconversion to Infected Participant Cohort (IPC) enrollment; median viral load (Roche PCR) in plasma and semen, and median CD4 count during the first six months after IPC enrollment.

RESULTS: 4892 men who have sex with men, heterosexual women, and injection drug users were recruited from 8 domestic HIVNET sites from April-October 1995. As of May 1996, 45 (39 men, 6 women) have seroconverted and been enrolled in the IPC, an average of 4 months after estimated seroconversion; the interval did not differ between those who sought care and those who did not. Of the 45 cases, 36 (82%) retrospectively reported greater than or equal to symptom consistent with an ARI and 25 (56%) sought care. The most frequent symptoms reported were fever (59%), headache (41%), sore throat (41%), and sweats (39%). Median CD4 count was 552 (range 186-1317) over the first 6 months. All had clade B virus. Median plasma HIV RNA was 18,535 copies (range less than 200-666,807). 63% of men had HIV detected in semen by RNA PCR; semen load was 1.75 lower and not highly correlated with plasma load. Initial plasma and semen viral load and CD4 count were not different between those seroconverters who sought medical care and those who did not. Of 229 tests performed by participant request for interim HIV testing, 7 were identified as HIV positive.

CONCLUSIONS: Seroconverters who sought medical care had similar initial virologic and immunologic parameters as those who did not seek medical care, but prospective follow-up will be necessary to determine if they have different viral set-points and clinical outcomes. Plasma viral load is not well correlated with semen viral load and therefore may not be a good marker of potential infectivity. Participant self-referral for early HIV testing identified approximately 20% of the HIVNET seroconverters prior to their scheduled testing date. Home collection for more frequent HIV testing will be studied in HIVNET as an additional method for earlier detection of seroconverters.

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