Human Immunodeficiency Virus Type 1 (HIV-1) Infection a Median of 18 Months before a Diagnostic Western Blot

Evidence from a Cohort of Homosexual Men

  1. Steven M. Wolinsky, MD;
  2. Charles R. Rinaldo, PhD;
  3. Shirley Kwok, BS;
  4. John J. Sninsky, PhD;
  5. Phalguni Gupta, PhD;
  6. David Imagawa, PhD;
  7. Homayoon Farzadegan, PhD;
  8. Lisa P. Jacobson, ScM;
  9. Kathie S. Grovit, BS;
  10. Moon H. Lee, PhD;
  11. Joan S. Chmiel, PhD;
  12. Harold Ginzburg, MD, JD;
  13. Richard A. Kaslow, MD; and
  14. John P. Phair, MD

    Abstract

    Study Objective: To study the natural history of human immunodeficiency virus type 1 (HIV-1) infection, we used an in-vitro amplification technique to detect HIV-1 nucleic acid sequences in sequential aliquots of peripheral blood mononuclear cells from homosexual men enrolled in the Multicenter AIDS Cohort Study.

    Design and Patients: Blinded, longitudinal study of 24 homosexual men who were positive for HIV-1 antibodies at a recent follow-up visit.

    Measurements and Main Results: Coded clinical samples were evaluated using two enzyme-linked immunosorbent assays (whole virus and gp120-gp41 fragment), Western blot, a p24 antigen capture assay, virus cocultivation, and in-vitro amplification of conserved regions from the HIV-1 gag and env open-reading frames. In 20 of the 24 men an HIV-1 enzymatically amplified product was detected before HIV-1 antibody seroconversion: at 42 months before seroconversion in two cases; at 36 months in one case; at 30 months in one case; at 24 months in four cases; at 18 months in eight cases; at 12 months in one case; and at 6 months in three cases (median, 18 months). In the four other men, detection of an HIV-1 enzymatically amplified product was concurrent with confirmation of antibody seroconversion by Western blot.

    Conclusions: There is a long and variable interval between virus acquisition and a diagnostic serum antibody response, perhaps due to the prolonged, persistent infection characteristic of the lentiviruses (family Retroviridae).

    Article and Author Information

    • From the Multicenter AIDS Cohort Study; Northwestern University Medical School, Chicago, Illinois; University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; Johns Hopkins University School of Public Health, Baltimore, Maryland; Harbor-UCLA Medical Center, Torrance, California; National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; and Cetus Corporation, Emeryville, California. For current author addresses, see end of text.

    • Grant Support: Supported in part by contracts N01-AI-72631, 72632, 72634, and 72636 from the National Institutes of Allergy and Infectious Diseases.

    • Requests for Reprints: Steven M. Wolinsky, MD, Department of Medicine, Northwestern University Medical School, 710 North Fairbanks, Chicago, IL 60611.

    • Current Author Addresses: Drs. Wolinsky, Chmiel, and Phair: Northwestern University Medical School, 710 North Fairbanks, Chicago, IL 60611.

      Drs. Rinaldo and Gupta and Ms. Grovit: A417 Crabtree Hall, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15261.

      Ms. Kwok and Dr. Sninsky: Cetus Corporation, 1400 53rd Street, Emeryville CA 94608.

      Drs. Imagawa and Lee: Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA 90509.

      Dr. Farzadegan and Ms. Jacobson: Johns Hopkins School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205.

      Dr. Kaslow: National Institute of Allergy and Infectious Diseases, 5333 Westbard Avenue, Bethesda, MD 20892.

      Dr. Ginzburg: Health Research Services Administration, 5600 Fishers Lane, Rockville, MD 20857.

    « Previous | Next Article »Table of Contents

    This Article

    1. Ann Intern Med December 15, 1989 vol. 111 no. 12 961-972
    1. » Abstract
    2. Full Text (PDF)

    Rapid Responses

    1. Submit a response
    2. No responses published

    Current Issue

    1. November 17, 2009, 151 (10)
    1. Alert me to current issues