Undetectable Viremia Not Rare among Recent HIV Seroconverters

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Nearly 7% of patients maintain undetectable viremia 5 years after HIV seroconversion without treatment with antiretroviral therapy (ART), a new study from France shows.

"These data should be considered when assessing virologic outcome for patients who interrupt HAART initiated during primary infection," Dr. Yoann Madec of INSERM and colleagues write in the May 1st issue of Clinical Infectious Diseases.

The researchers assessed the frequency of periods of undetectable viremia in 426 HIV-infected patients not taking ART for whom serial measurements of HIV were available. The subjects were enrolled in the study between 1988 and 1995, and measurements were taken every 6 months.

Thirty-six of the patients achieved undetectable viremia, defined as two or more consecutive HIV RNA measurements below 400 or 500 copies/mL. One year after infection, 3.5% had undetectable viremia, while the percentage of patients with undetectable viremia 2 years after infection was 5.5%. Five years after seroconversion, 6.7% of patients had undetectable levels of HIV.

Women were 2.44 times as likely as men to achieve undetectable viremia, as were patients with low HIV RNA or DNA levels at baseline and high CD4 counts. Duration of undetectable viremia also was related to HIV RNA and DNA levels at baseline. The duration of undetectable viremia ranged from 4.6 to 62.8 months, with a median of 11.9 months.

In an editorial accompanying the findings, Dr. Elizabeth Connick and colleagues from the University of Colorado at Denver and Health Sciences Center note that an early, uncontrolled study suggested significant clinical benefit of HAART in patients with acute HIV infection, leading to the conventional wisdom that it would be unethical to withhold treatment for these patients.

For this reason there have been few randomized, controlled clinical trials in patients recently infected with HIV, which the editorialists call "a great disservice to HIV-infected patients."

"Although studies of HIV seroconverters pose multiple logistical, statistical and clinical challenges," Dr. Connick's group concludes, "the proper design and performance of these studies are critical to gain better insight into HIV immunopathogenesis and optimal treatment strategies."

05/16/05

Clin Infect Dis 2005;40:1350-1357.