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Acute Retroviral Syndrome is Associated with High Viral Burden, CD4 Depletion, and Immune Activation in Systemic and Tissue Compartments

  1. Author:
    Crowell, Trevor A
    Colby, Donn J
    Pinyakorn, Suteeraporn
    Fletcher, James L K
    Kroon, Eugène
    Schuetz, Alexandra
    Krebs, Shelly J
    Slike, Bonnie M
    Leyre, Louise
    Chomont, Nicolas
    Jagodzinski, Linda L
    Sereti, Irini
    Utay, Netanya S
    Dewar, Robin
    Rerknimitr, Rungsun
    Chomchey, Nitiya
    Trichavaroj, Rapee
    Valcour, Victor G
    Spudich, Serena
    Michael, Nelson L
    Robb, Merlin L
    Phanuphak, Nittaya
    Ananworanich, Jintanat
  2. Author Address

    U.S. Military HIV Research Program, Walter Reed Army Institute of Research, USA., Henry M. Jackson Foundation for the Advancement of Military Medicine, USA., SEARCH, Thai Red Cross AIDS Research Centre, Thailand., Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, Thailand., Centre de Recherche du CHUM and Department of Microbiology, Infectiology and Immunology, Universit 233; de Montr 233;al, Canada., National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA., Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, USA., Virus Isolation and Serological Lab, National Cancer Institute at Frederick, USA., Department of Medicine, Faculty of Medicine, Chulalongkorn University, Thailand., Memory and Aging Center, Department of Neurology, University of California San Francisco School of Medicine, USA., Department of Neurology, Yale University School of Medicine, USA., Department of Global Health, The University of Amsterdam, The Netherlands.,
    1. Year: 2018
    2. Date: May 15
    3. Epub Date: 2017 12 07
  1. Journal: Clinical Infectious Diseases
    1. 66
    2. 10
    3. Pages: 1540-1549
  2. Type of Article: Article
  1. Abstract:

    Many individuals with acute HIV infection (AHI) experience acute retroviral syndrome (ARS), which is associated with adverse long-term clinical outcomes. We characterized clinical, virologic, and immunologic features of ARS and described the impact of early antiretroviral therapy (ART) initiation. Participants presenting for voluntary HIV testing were enrolled during AHI in Bangkok, Thailand. ARS was defined by =3 qualifying signs/symptoms. HIV burden, immunophenotypes, and biomarkers were stratified by ARS diagnosis at enrollment and after up to 96 weeks of ART. From 212,382 samples screened, 430 participants were enrolled during AHI, including 335 (78%) with ARS. Median age was 26 years and 416 (97%) were men. Sixty (14%) underwent sigmoid biopsy and 105 (24%) underwent lumbar puncture during AHI. Common symptoms included fever (93%), fatigue (79%), pharyngitis (67%) and headache (64%). Compared to those without ARS, participants with ARS were in later Fiebig stages with higher HIV RNA in blood, colon, and cerebrospinal fluid; higher total HIV DNA in blood; CD4 depletion in blood and colon; and elevated plasma TNFa, C-reactive protein, and D-dimer (all p-values < 0.05). Subgroup analyses of Fiebig I/II participants (95 with ARS, 69 without) demonstrated similar findings. After 96 weeks of ART, TNFa and IL-6 were elevated in the ARS group (p-values < 0.05) but other biomarkers equilibrated. ARS was associated with high viral burden, CD4 depletion and immune activation across multiple body compartments during AHI and prior to ART. Persistent inflammation despite suppressive ART could contribute to increased morbidity in individuals who experience ARS.

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External Sources

  1. DOI: 10.1093/cid/cix1063
  2. PMID: 29228130
  3. PMCID: PMC5930255
  4. WOS: 000432184200014
  5. PII : 4706268

Library Notes

  1. Fiscal Year: FY2017-2018
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