Early human immunodeficiency virus (HIV) infection in the HIV network for prevention trials vaccine preparedness cohort: Risk behaviors, symptoms, and early plasma and genital tract virus load

Risk behaviors, symptoms, and virologic characteristics were studied among 103 human immunodeficiency virus (HIV) seroconverters in vaccine preparedne ss cohorts during 1995-1998. Overall, 83% of subjects were men who had sex with men; most reported multiple risk episodes and symptoms (84%, greater t han or equal to1 symptom) during seroconversion. Acute HIV was diagnosed in only 8 of 50 who sought medical care. Median initial pretreatment plasma v irus load was 25,800 copies/mL (range, undetectable-262,000 copies/mL) a me an of 4 months after seroconversion, and 9.7% had nucleoside-associated mut ations; none had multidrug resistance. Semen virus load was more variable, 1.3 log(10) lower and modestly correlated (r = .28; 95% confidence interval , 0.16-0.42) with plasma among untreated men. When the plasma RNA level was <5000 copies/mL, 32% of untreated men, 13% on nucleoside regimens, and 7% on protease inhibitor-containing regimens had detectable seminal RNA. Acute HIV was seldom diagnosed, representing missed opportunities for early trea tment and prevention. Most subjects had several relatively stable virus loa ds before initiation of antiretrovirals, indicating feasibility of assessin g HIV vaccines on virus set point in efficacy trials.