HIV in body fluids during primary HIV infection: implications for pathogenesis, treatment and public health

Objective: To describe initial viral dissemination to peripheral tissues an d infectious body fluids during human primary HIV infection. Design: Observational cohort study. Methods: Blood plasma, cerebrospinal fluid (CSF), seminal plasma, cervicova ginal lavage fluid and/or saliva were sampled from 17 individuals with prim ary HIV infection (range of time from symptoms onset to sampling, 8-70 days ) and one individual with early infection (168 days). Subjects' HIV-1 RNA l evels in each fluid were compared with levels from antiretroviral-naive con trols with established HIV infection. For study subjects, correlations were assessed between HIV-1 RNA levels and time from symptoms onset. Responses to antiretroviral therapy with didanosine + stavudine + nevirapine +/- hydr oxyurea were assessed in each compartment. Results: HIV-1 RNA levels were highest closest to symptoms onset in blood p lasma (18 patients) and saliva (11 patients). CSF HIV-1 RNA levels (five pa tients) appeared lower closer to symptoms onset, although they were higher overall in primary versus established infection. Shedding into seminal plas ma (eight patients) and cervicovaginal fluid (two patients) was established at revels observed in chronic infection within 3-5 weeks of symptoms onset . High-level seminal plasma shedding was associated with coinfection with o ther sexually transmitted pathogens. Virus replication was suppressed in al l compartments by antiretroviral therapy. Conclusions: Peak level HIV replication is established in blood, oropharyng eal tissues and genital tract, but potentially not in CSF, by the time pati ents are commonly diagnosed with primary HIV infection. Antiretroviral ther apy is unlikely to limit initial virus spread to most tissue compartments, but may control genital tract shedding and central nervous system expansion in primary infection. (C) 2001 Lippincott Williams & Wilkins.