Severe Seroconversion Symptoms Predict Faster HIV Disease Progression

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People who experience more severe symptoms or who have lower CD4 T-cell counts when they first become infected with HIV are more likely to experience faster disease progression later on, according to an international study described in the November 14, 2013, edition of PLoS Medicine.

A majority of people experience some flu-like symptoms when they first contract HIV, a period known as primary HIV infection. These may include fever, fatigue, sore throat, swollen lymph nodes, rash, and muscle or joint aches. This acute retroviral syndrome or seroconversion illness is generally mild, but some people experience more severe symptoms, such as thrush (oral candidiasis), indicating rapid immune suppression.

Sara Lodi from Instituto de Salud Carlos III in Madrid and fellow investigators with the CASCADE Collaboration looked at symptoms during primary HIV infection and their association with future disease progression.

The risks and benefits of starting antiretroviral therapy (ART) during primary HIV infection are not yet clear, the researchers noted as background. Some research suggest this may lead to lower viral load set-point and even viral suppression after stopping treatment in a small percentage of patients.

This retrospective analysis included 1108 CASCADE cohort participants infected with HIV for less than 6 months. Most (85%) were men and 71% were infected through sex between men; the median CD4 count during primary infection was 511 cells/mm3. Participants were classified as having severe or non-severe primary HIV infection based on whether they experienced specific pre-defined severe symptoms including thrush, bronchitis, and pneumonia, central nervous system symptoms, or CD4 counts <350 or <500 cells/mm3.

The researchers compared time to AIDS or death, with follow-up ending at either the last clinic visit or the beginning of 1997, when effective combination ART became generally available.

Results

"One CD4 count <350 or two <500 cells/mm3 within 6 months of seroconversion and/or severe illness in primary HIV infection may be useful early indicators of individuals at high risk of disease progression," the researchers concluded.

Based on these findings, they suggested that people with severe symptoms during primary infection may benefit from starting antiretroviral treatment promptly.

12/18/13

Reference

S Lodi, M Fisher, A Phillips, et al (CASCADE Collaboration). Symptomatic Illness and Low CD4 Cell Count at HIV Seroconversion as Markers of Severe Primary Infection. PLoS ONE 8(11):e78642. November 14, 2013.