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Intermittent Low-Level Viremia in Very Early Primary HIV-1 Infection

Fiebig, Eberhard W MD*†; Heldebrant, Charles M PhD; Smith, Richard I. F PhD; Conrad, Andrew J PhD; Delwart, Eric L PhD§∥; Busch, Michael P MD, PhD*§¶

JAIDS Journal of Acquired Immune Deficiency Syndromes: June 1st, 2005 - Volume 39 - Issue 2 - p 133-137
doi: 10.1097/01.qai.0000162418.70372.c3
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Serial samples from source plasma donors with confirmed new HIV infection were investigated for low-level viremia (LLV) (ie, <100 genome copies [cp]/mL) at time points preceding the period of steadily rising viremia above 100 cp/mL (ramp-up viremia). Fifteen of 44 plasma donor panels previously studied for the dynamics of HIV viremia during primary infection contained 70 samples with undetectable HIV-1 RNA by quantitative polymerase chain reaction (PCR). On retesting with a sensitive qualitative reverse transcriptase PCR assay (95% detection at 4 cp/mL), we identified LLV in 13 of 15 panels and 23 of 69 retested samples. In 6 panels, a total of 11 samples (1-3 per panel) were consistent with LLV before ramp-up viremia. These samples preceded the first sample with >100 cp/mL HIV by 9 to 25 days (median = 18 days) and were separated from the latter by at least 1 sample with undetectable viremia by the qualitative PCR assay. We conclude that LLV is not uncommon during the very early period of primary HIV infection preceding ramp-up viremia. It is not known if blood is infectious during this period; however, given the low viral concentrations and transient nature of the observed viremic “blips,” the risk of infectivity can be assumed to be small.

From the *Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA; †San Francisco General Hospital Medical Center, San Francisco, CA; ‡National Genetics Institute, Los Angeles, CA; §Blood Centers of the Pacific, San Francisco, CA; ∥Department of Medicine, University of California, San Francisco, CA; and ¶Blood Systems, Inc., Scottsdale, AZ.

Received for publication November 24, 2004; accepted March 4, 2005.

Supported by National Institutes of Health grants N01-HB-47114 and U01-AI-41531.

Reprints: Michael P. Busch, Blood Centers of the Pacific, 270 Masonic Avenue, San Francisco, CA 94118 (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.