Primary human immunodeficiency virus-1 infection: Clinical, virological and immunological characteristics of a braziliam cohort

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Background: Primary HIV-1 infection (PHI) consists in the period of time between viral acquisition and seroconversion, its hallmark is high viremia and consequently increased infectiousness. The occurrence, severity and duration of symptoms are predictive factors of clinical deterioration. We report here the epidemiological, clinical, virological and immunological characteristics of a cohort of patients with PHI.

Methods: Prospective observational study of patients with PHI at the Emilio Ribas Institute of Infectious Diseases, a tertiary hospital in Sao Paulo, Brazil. Inclusion criteria included negative or undetermined HIV-1 serology associated with viral detection, or clinical and serological evidence of seroconversion during the last 6 months. Epidemiological history, clinical data, HIV-1 plasma viral load, CD4 cell count, genotypic resistance testing, serology for hepatitis B, C, A, toxoplasmosis, cytomegalovirus, herpes and syphilis were recorded as well as the use of highly active antiretroviral treatment (HAART).

Results: Between 2007 and 2009, 10 patients met the inclusion criteria (8 males and 2 females, median age was 34). Two patients were asymptomatic and eight were symptomatic. The main symptoms were fever (80%), myalgia (60%), rash (30%), hepatitis (20%) aseptic meningitis (20%) and renal failure (10%). Only 4 patients had a mononucleosis-like illness. Homosexual transmission route was more frequent (60%). Five patients had plasma viral load above the upper limit of detection and the median CD4 cell count was 395cel/mm+ (range: 47–835cel/mm+). Five patients received HAART and among 5 patients who did not receive HAART, 2 patients had clinical and immunological criteria for initiating HAART after 12 months of follow-up. Genotypic resistance testing was available for 4 patients. Overall patients had triple class susceptible HIV-1 sub-type B strain. One patient had primary resistance to non-nucleoside reverse transcriptase inhibitors and several protease inhibitors mutations and this finding was correlated with clinical severity.

Conclusion: Clinical, virological and immunological parameters in PHI may be heterogenous, atypical clinical presentation is frequent. Determinating resistance profile is useful for early therapeutic intervention, which is associated with better outcome.