Study of Early HIV Infection May Lead to New Treatments

A prospective, multi-national study that investigated the virological and immunological changes caused by HIV provided a better understanding of immune defense mechanisms and could lead to better vaccination strategies.

Over the course of several years, investigators tested more than 2000 people twice weekly in Tanzania, Kenya, Uganda, and Thailand who are at high risk of HIV.

Researchers used a method called APTIMA, which is able to detect low concentrations of about 20 copies of HIV ribonucleic acid (RNA) per milliliter of plasma to detect new HIV infections. There were 112 people confirmed HIV-positive after only a few days of infection, an average of 5 days between the last negative and the first positive blood test.

The findings from 50 patients within the cohort were published in the New England Journal of Medicine.

“Conducting this study (RV 217) was very challenging,” said clinical research coordinator Inge Kroidl. “We had major doubts about whether the study participants who were members of very mobile and partially stigmatized high-risk groups would be willing to participate in such a complex study.”

During the acute stage of HIV infection, researchers collected data on the course of immune reactions and viremia for the RV 217 study. The results revealed that on average, the duration between the first confirmation of HIV-RNA and peak viremia was 13 days, while the viral load set point was 31 days.

Further course of disease was determined by the set point defined in the first days after HIV infection, while the levels of viremia determine whether the course of HIV will be rapid or slow. Authors noted that information on the interactions between the virus and the immune system are crucial.

The RV 217 study first began in 2009, and is still recruiting patients. During the acute stage, about half of the newly infected patients were treated with antiretroviral therapy.

“Long-term goals of these investigations, which we are also conducting with a German cohort at the DZIF, is to develop strategies to eradicate HIV from the body and to achieve long-term HIV remission, and possibly even a cure,” said researcher Arne Kroidl.