HealthDay News — Few symptoms and signs are observed during acute HIV-1 infection, and these are most common before peak viremia, according to a study published online in the New England Journal of Medicine.

Merlin L. Robb, MD, from the Walter Reed Army Institute of Research in Silver Spring, Md., and colleagues performed twice-weekly qualitative plasma HIV-1 RNA nucleic acid testing in 2,276 volunteers at high risk for HIV-1 infection.

Fifty of 112 volunteers with acute HIV-1 infection had two or more blood samples collected before HIV-1 antibody detection. The researchers found that the median peak viremia occurred 13 days after nucleic acid testing reactivity appeared in the first sample. At a median of 14 days, reactivity on an enzyme immunoassay occurred. At a median of 31 days, the nadir of viremia occurred, which was nearly equivalent to the viral-load set point, the steady-state viremia that persists durably after viremia resolution. 

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There was a correlation between peak viremia and downslope with viral-load set point. Just before and at the time of peak viremia, clinical manifestations of acute HIV-1 infection were most common. A median of one symptom of acute HIV-1 infection and one sign of acute HIV-1 infection were recorded at a median of two and three visits, respectively.

“During the acute phase, identification of cases of HIV-1 on the basis of clinical criteria may prove to be difficult,” the authors write.


1. Robb ML, Eller LA, Kbuuka H, et al. Prospective Study of Acute HIV-1 Infection in Adults in East Africa and Thailand. N Engl J Med. 2016; DOI: 10.1056/NEJMoa1508952.