ABSENCE OF PROLONGED IMMUNOSILENT INFECTION WITH HUMAN-IMMUNODEFICIENCY-VIRUS IN INDIVIDUALS WITH HIGH-RISK BEHAVIORS

PURPOSE: The presence in some individuals of a prolonged phase of infe ction with human immunodeficiency virus type 1 (HIV-1) before seroconv ersion remains controversial. This study was undertaken to determine w ith a sensitive in vitro amplification technique, the polymerase chain reaction (PCR), whether seronegative individuals with high-risk behav iors could harbor HTV-1 sequences in their peripheral blood mononuclea r cells (PBMCs) and remain seronegative for more than 6 months. PATIEN TS AND METHODS: Seronegative individuals who engaged in unprotected an ogenital intercourse with HIV-1-infected partners or with more than 10 individuals per year, and seronegative individuals who shared needles with seropositive partners, were recruited prospectively over 18 mont hs. HTV-1 DNA and RNA sequences were detected in PBMCs of these indivi duals with three PCR assays using SK38/SK39, SK145/SK431, and SK68/SK6 9. Seronegative but PCR-positive patients were also evaluated with p24 antigen capture assay, radioimmunoprecipitation assay, and Western bl ot. The latter patients were followed prospectively to reproduce PCR-p ositive results and monitor serologic responses. RESULTS: Sixty-one me n and 18 women, with an average age of 34.1 +/- 7.6 years, were recrui ted: 56 were homosexual men, 18 were heterosexual women, and 5 were he terosexual men. Amplification reactions for HIV-1 of 104 PBMC specimen s from 79 patients with negative or indeterminate serologies revealed that 4 patients (5.1%) were positive with PCR for HIV-1 DNA and RNA at the time of enrollment. Positive amplification reactions could not be reproduced in prospective samples for one patient. The analysis of a variable human genomic locus in this patient's PBMCs demonstrated that the first PCR-positive sample and following PCR-negative samples orig inated from different patients, suggesting a specimen mix-up. Two of t he three PCR-positive seronegative patients had symptoms suggestive of acute retroviral disease. Sera from all three patients contained p24 antigen. Two patients seroconverted within 1 month whereas one patient could not be followed prospectively. CONCLUSION: Prolonged infection with HIV-1 without seroconversion was not found in our population of p atients at very high risk for HIV-1 infection. All PCR-positive patien ts seroconverted in less than 1 month.