High-level viremia in adults and children infected with human immunodeficiency virus: relation to disease stage and CD4+ lymphocyte levels

Article Abstract:

Infection with human immunodeficiency virus type I (HIV-I) is characterized by the progressive deterioration of the immune and nervous systems and disorders of the blood, heart, lungs, kidneys, and gastrointestinal tract. The replication of HIV leads to high levels of the virus in the blood, and enhances the transmission and development of the disease. Studies show that HIV-I infects the CD4+ lymphocytes, a type of immune cell, in blood and brain cells derived from monocytes, a type of white blood cell. Increases in the number of infected cells and the quantity of viral DNA produced are associated with progression of HIV disease. HIV p24 antigen is a measure of HIV-1 replication and can be detected in the early stages of HIV disease and when there are low numbers of CD4+ cells. The presence of cell-free HIV in the blood (virus not associated with cells) is also a measure of HIV-1 replication and was shown to increase in relation to elevations in p24 antigen levels and disease progression. The relations between levels of cell-free HIV in the blood, patient age at diagnosis, number of CD4+ lymphocytes, indicators of HIV infection, clinical stage of disease, and response to antiviral agents were assessed in 68 adults and 9 children with HIV-I infection. Viremia, or the presence of cell-free HIV in the blood, had developed in 18 of 68 adults and 5 of 9 children. Among the adults, viremia was detected in none of the patients without symptoms; 4 of 34 patients with AIDS-related complex (ARC); and 14 of 15 patients with AIDS. Patients with CD4+ lymphocyte numbers greater than 400 per cubic millimeter had no viremia, whereas cell-free HIV was detected in the blood of 3 of 17 patients with CD4+ counts between 200 to 400 per cubic millimeter and 15 of 16 patients with less than 200 CD4+ lymphocytes per cubic millimeter. All children infected with HIV during pregnancy or childbirth developed viremia regardless of the number of CD4+ cells, duration of infection, or clinical stage. Viremia was less prevalent among children infected at an older age. The antiviral agent zidovudine was effective in decreasing the amount of cell-free HIV in eight patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Causes of, Physiological aspects, Demographic aspects, Viremia, Lymphocytes

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High titers of cytopathic virus in plasma of patients with symptomatic primary HIV-1 infection

Article Abstract:

To learn more about the course of acute infection by human immunodeficiency virus type 1 (HIV-1), which causes AIDS, four patients with symptoms of such infection (fever, nausea, headache, muscle pains) were studied. The development of viremia (viral particles in the bloodstream) and HIV-1 antibody production were characterized. The sexual histories of the patients, who were all homosexual men, were known. High levels of infectious HIV-1 appeared in patients' blood between 6 and 15 days after symptoms began. By the time the patients were released from the hospital (four to seven days after admission because of their symptoms), blood levels of virus had fallen considerably. Two patients developed their first symptoms 20 and 28 days, respectively, after infection; antibodies to HIV-1 became detectable in these cases 40 and 39 days after infection. Detailed descriptions are presented of the course of each patient's viremia and antibody production against viral proteins. Based on the biologic characteristics of the viruses cultured from these patients, it seems likely that viruses capable of rapid replication can be transmitted through sexual contact, leading to symptoms and antibody production within a short time. Viral concentrations then fall. In other cases, less virulent strains may be involved, leading to longer periods when viruses can be detected, before antibody production has not yet begun. A model is presented of the natural history of HIV-1 infection. The course of symptomatic primary infection with this deadly virus needs further investigation, since it continues to occur at a high rate in the US. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Development and progression

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Assessment of antiretroviral therapy by plasma viral load testing: standard and ICD HIV-1 p24 antigen and viral RNA (QC-PCR) assays compared

Article Abstract:

A new test for measuring the amount of HIV in the blood plasma may better detect changes in viral load in response to drug treatments. Researchers compared the new test, quantitative competitive-polymerase chain reaction (QC-PCR), to three other tests to evaluate changes in HIV viral load in 46 HIV patients participating in a clinical trial of the antiretroviral drugs zidovudine and L-697,661. The QC-PCR test was able to measure viral load in all 46 patients throughout the study, whereas the other tests could not measure it in all patients all of the time. It could detect lower levels of virus in plasma than the commonly used p24 antigen test or the ICD p24 antigen test. The QC-PCR test indicated that patients developed resistance to L-697,661, and treatment with this drug was stopped.

Evaluation, Polymerase chain reaction, HIV testing, HIV tests

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