Table 2.
Detection, staging, and treatment of acute HIV infection
| Viral load at detection | Fiebig stage | Viral load ramp-up * | Peak viral load | Treatment | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Days since negative viral load | Log copies10 per mL | Days after detection until seen | Number of visits | Number of samples (blood, FGT, stool) | Log copies10 per mL | Days to peak viral load | Started cART | Days to treatment initiation | Time to <20 copies per mL (days) | ART regimen | ||
| Untreated acute HIV infection (n=14) | ||||||||||||
| 1 | 4 | 2·67 | 2 | I | 4 | 1 | 7·04 | 7 | ·· | ·· | ·· | ·· |
| 2 | 4 | 4·85 | 1 | I | 4 | 1 | 7·76 | 7 | Yes | 724 | 120 | 3 drug |
| 3 | 4 | 3·29 | 1 | I | 4 | 2 | 6·91 | 10 | Yes | 310 | 174 | 3 drug |
| 4 | 3 | 4·57 | 4 | I | 3 | 2 | 7·48 | 11 | Yes | 347 | Withdrew | 3 drug |
| 5 | 4 | 2·20 | 2 | I | 5 | 2 | 7·72 | 10 | Yes | 809 | 109 | ·· |
| 6† | 4 | 5·03 | 1 | I | 4 | 2 | 7·11 | 7 | ·· | ·· | ·· | ·· |
| 7 | 4 | 1·99 | 2 | I | 7 | 3 | 6·60 | 17 | Yes | 456 | 156 | 3 drug |
| 8 | 3 | 4·57 | 1 | I | 6 | 3 | 6·98 | 15 | Yes | ·· | 98 | 3 drug |
| 9 | 3 | 3·23 | 1 | I | 4 | 2 | 6·99 | 8 | ·· | ·· | ·· | ·· |
| 10 | 21 | 5·76 | 1 | III | 3 | 1 | 8·29 | 4 | ·· | ·· | ·· | ·· |
| 11 | 3 | 2·97 | 1 | I | 5 | 2 | 7·15 | 7 | Yes | 427 | 70 | 3 drug |
| 12 | 4 | 4·51 | 1 | I | 4 | 2 | 7·15 | 7 | ·· | ·· | ·· | ·· |
| 13 | 3 | 2·95 | 1 | I | 5 | 2 | 5·89 | 11 | ·· | ·· | ·· | ·· |
| 14 | 4 | 4·45 | 1 | I | 4 | 2 | 8·00 | 7 | Yes | 528 | ·· | 3 drug |
| Median (IQR) | 4·00 (3·00–4·00) | 3·87 (2·96–4·57) | 1·00 (1·00–1·75) | ·· | 4·00 (4·00–5·00) | 2·00 (2·00–2·00) | 7·13 (6·98–7·66) | 7·50 (7·00–10·75) | ·· | ·· | 114·50 (100·75–147·00) | ·· |
| Treated acute HIV infection (n=28) | ||||||||||||
| 15 | 7 | 3·78 | 1 | I | 2 | 2 | 4·37 | 1 | Yes | 1 | 27 | 3 drug |
| 16 | 7 | 1·99 | 1 | I | 3 | 1 | 4·53 | 2 | Yes | 1 | 18 | 3 drug |
| 17 | 45 | 4·92 | 1 | V | Not detected‡ | Not detected‡ | 4·92 | 0 | Yes | 1 | 72 | 3 drug |
| 18 | 42 | 1·99 | 1 | V | 2 | 0 | 2·11 | 0 | Yes | 3 | 9 | 3 drug |
| 19 | 4 | 4·04 | 1 | I | 3 | 1 | 5·55 | 3 | Yes | 1 | 62 | 3 drug |
| 20 | 3 | 2·28 | 1 | I | 4 | 2 | 3·34 | 7 | Yes | 1 | 25 | 3 drug |
| 21 | 78 | 5·37 | 1 | III | 2 | 2 | 5·88 | 1 | Yes | 1 | Withdrew | 3 drug |
| 22 | 3 | 3·72 | 1 | I | 3 | 1 | 5·32 | 4 | Yes | 1 | 38 | 3 drug |
| 23 | 5 | 2·91 | 3 | I | 3 | 1 | 4·61 | 7 | Yes | 3 | 21 | 3 drug |
| 24 | 4 | 2·75 | 1 | I | 2 | 1 | 3·77 | 1 | Yes | 1 | 13 | 3 drug |
| 25 | 3 | 2·43 | 2 | I | 3 | 1 | 4·95 | 3 | Yes | 3 | 78 | 3 drug |
| 26 | NA§ | 5·32 | 1 | V | Not detected‡ | Not detected‡ | 5·32 | 0 | Yes | 1 | 22 | 4 drug |
| 27 | 3 | 3·64 | 1 | I | 2 | 1 | 4·72 | 1 | Yes | 1 | 13 | 4 drug |
| 28 | 3 | 3·65 | 2 | I | 3 | 1 | 6·41 | 4 | Yes | 2 | 33 | 4 drug |
| 29 | 3 | 2·40 | 1 | I | 2 | 1 | 4·15 | 1 | Yes | 1 | 17 | 4 drug |
| 30 | 10 | 7·57 | 1 | III | 1 | 0 | 7·57 | 0 | Yes | 1 | 27 | 4 drug |
| 31 | 3 | 1·99 | 1 | I | 1 | 1 | 4·22 | 1 | Yes | 1 | 10 | 4 drug |
| 32 | 4 | 2·56 | 1 | I | 4 | 3 | 3·86 | 7 | Yes | 1 | 13 | 4 drug |
| 33 | 4 | 2·64 | 1 | I | 1 | 0 | 2·64 | 0 | Yes | 1 | 6 | 4 drug |
| 34 | 7 | 3·76 | 2 | I | 3 | 2 | 4·93 | 4 | Yes | 2 | 16 | 4 drug |
| 35 | 4 | 2·23 | 1 | I | 3 | 1 | 2·89 | 3 | Yes | 1 | 13 | 4 drug |
| 36 | 4 | 2·75 | 1 | I | 3 | 1 | 3·20 | 3 | Yes | 1 | 15 | 4 drug |
| 37 | 5 | 4·88 | 1 | I | 2 | 1 | 5·45 | 1 | Yes | 1 | 41 | 4 drug |
| 38 | 4 | 2·97 | 1 | I | 1 | 0 | 2·97 | 0 | Yes | 1 | 9 | 4 drug |
| 39 | 4 | 3·23 | 1 | I | 3 | 1 | 3·75 | 3 | Yes | 1 | 20 | 4 drug |
| 40 | 3 | 1·99 | 1 | I | 2 | 1 | 2·96 | 1 | Yes | 1 | 11 | 4 drug |
| 41 | 3 | 1·99 | 1 | I | 2 | 1 | 3·19 | 1 | Yes | 1 | 6 | 4 drug |
| 42 | 4 | 4·27 | 1 | I | Not detected‡ | Not detected‡ | 4·27 | 0 | Yes | 1 | 9 | 4 drug |
| Median (IQR) | 4·0 (3·00–6·00) | 2·94 (2·37–3·85) | 1·0 (1·00–1·00) | ·· | 2·00 (2·00–3·00) | 1·00 (1·00–1·00) | 4·3 (3·31–5·04) | 1·0 (0·75–3·00) | ·· | 1·0 (1·00–1·00) | 17·0 (12·00–27·00) | ·· |
Of 42 individuals diagnosed with acute HIV-1 infection after study enrolment, 14 were untreated and 28 received immediate ART after detection. 36 were diagnosed during Fiebig stage I, including 13 in the untreated group and 23 in the treated group. Of the 28 participants who received immediate treatment, 11 received a standard three-drug regimen of tenofovir, emtricitabine, and efavirenz (given once per day as a fixed-dose combination pill) and 17 received a four-drug regimen that also included raltegravir. FGT=female genital tract. ART=combination antiretroviral therapy. NA=not applicable.
Viral load ramp-up describes the period between HIV detection and peak viraemia, and thus is indicative of rapid viral replication.
This individual was assigned Fiebig stage I based on a 4 day gap since the last negative result for HIV RNA, although no p24 antigen result was available on the day of detection and the initial viral load was high (5·03 log 10 copies per mL).
Three participants were not detected during viral load ramp-up because the second viral load was equal to or less than the viral load at detection.
Days since the last negative viral load was NA for this individual because HIV RNA was detected on the first day of screening.