Primary HIV Infection — Predicting the Set Point

Summary and Comment |
June 18, 2007

Primary HIV Infection — Predicting the Set Point

  1. Charles B. Hicks, MD

Having a greater number of symptoms during primary infection was associated with a higher initial viral load, which, in turn, was associated with a higher viral set point.

  1. Charles B. Hicks, MD

Unfortunately, diagnosis of acute HIV infection is an uncommon event, and the advantages of such early diagnosis are not always apparent to the patient or even to the provider. Understanding the association between symptoms, initial HIV viremia, and ultimate viral set point may help determine treatment decisions for such patients.

Investigators in San Francisco conducted a prospective cohort study involving 57 patients with primary HIV infection and 127 patients with recent HIV seroconversion. Upon enrollment, all study participants were asked about a recent history of any of 21 symptoms that are characteristic of primary infection.

Patients who had their HIV infection diagnosed before seroconversion (i.e., during acute or primary infection) reported significantly more symptoms than did those who received their diagnosis after seroconversion (mean, 9 vs. 6); they also had significantly higher viral loads at study entry (mean, 5.1 vs. 4.4 log copies/mL). In both groups, having a greater number of symptoms during acute infection was associated with a higher initial viral load. Among the 48 patients (6 with acute infection, 42 with seroconversion) who did not start antiretroviral therapy (ART) before a set point was established, a higher initial viral load was, in turn, associated with a higher set point.

The predictive value of the initial viral load on the subsequent set point was considered by the authors to suggest that early interactions between the virus and the host’s innate immune system were important in determining the set point. By extension, the adaptive immune response (which develops later) was thought to be less critical, although the number of patients with acute infection who did not initiate ART was quite low, making any such conclusions tenuous.


These findings support the results of previous studies that showed more-rapid rates of progression to AIDS among patients who present with more-symptomatic acute HIV infection. The higher viral set point seen in the more-symptomatic patients in this study may reflect a less-effective immune response to the initial infection or, alternatively, a more pathogenic virus. Given the association between number of symptoms, initial viral load, and ultimate viral set point, one might be tempted to speculate that patients with more symptoms would benefit from early initiation of treatment during primary HIV infection. However, data demonstrating value from such an approach are not compelling. Nonetheless, the possibility that ART that was administered during symptomatic primary infection might favorably affect the viral set point provides an additional reason to advocate treatment during acute HIV infection.


Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.