A.17.Rapid resolution of HIV shedding associated with acute HIV and acute std infections: implications for HIV prevention and control
by Pilcher C, Mapanje C, Hoffman I, Chilongozi D, Martinson F , Krysiak R, Gama S, Miller W, Cohen M, Fiscus S
Background: Epidemiologic evidence now suggests both infection with classical STDs, (in particular, genital ulcer disease) and the period of high viremia associated with acute HIV disease can facilitate HIV transmission. To better understand the biological determinants of infectiousness in both acute HIV disease and HIV/STD co-infection, we conducted a longitudinal cohort study among acutely and chronically HIV infected individuals with coincident STDs.
Methods: We recruited consecutive attendees of both genders presenting to the KCH STD clinic for care of a new STD. Consenting clients received HIV VCT with 2 rapid test screening and WB, RNA and p24 antigen confirmatory testing. Ab -/indeterminate subjects that were p24+ or RNA+ were followed prospectively for seroconversion; acute clients and gender-matched HIV+ controls donated blood plasma (BP) and genital secretions (seminal plasma, SP; cervico-vaginal fluid, CV) at weeks 1,2,4,8,12 and 16. RNA in SP and CV used NucliSens.
Results: 587 (40.8%) of 1440 clients were HIV+: 555 had Ab+ established HIV infection and 20 had Ab- AHI. 15 acutely HIV+ subjects and 36 HIV+ control subjects donated both blood and genital secretions. For 5 acutely HIV+ men, mean changes in VL at wks 8 and 16 were -1.54 and -2.49 log in SP, vs. -0.64 and -0.99 log in BP. SP RNA levels appeared to diminish more rapidly than BP RNA. Data from additional acute subjects and from control subjects with STD treatment will be presented.
Discussion: Patients presenting for acute STD care at KCH may frequently have acute HIV infection as well. Such clients can have extremely high levels of genital HIV shedding. The fact that this high level shedding resolves quickly (within 8 weeks) points to the urgent necessity of identifying such patients in real time.