The effect of acute infectious illnesses on plasma human immunodeficiency virus (HIV) type 1 load and the expression of serologic markers of immune activation among HIV-infected adults

The effect of acute coinfections on plasma human immunodeficiency virus (HI V) load and immune activation markers was evaluated. Thirty-two HIV-infecte d persons were prospectively enrolled; 18 had pre-illness, acute, and follo w-up specimens. Plasma HIV RNA levels were determined by reverse transcript ase-polymerase chain reaction, and serum levels of activation markers, incl uding tumor necrosis factor (TNF)-alpha, soluble (s) TNF receptors (R)-I an d -II, interleukin (IL)-2, IL-6, IL-10, sIL-2R, sCD4, and sCD8, were assess ed by commercial ELISAs. Median plasma HIV load increased 7.8-fold during i llness (P =.001) and decreased 1.5-fold (P =.01) during convalescence (medi an, 15 days), Significant virus load reductions were limited to subjects wi th clinical recovery. By regression analysis, changes in plasma HIV RNA wer e significantly associated with changes in sTNFR-I, sTNFR-II, and sIL-2R. I ncreased HIV replication during acute coinfections is associated with in vi vo immune activation, which underscores the need to prevent and promptly tr eat intercurrent illnesses.