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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

Steven M. Wolinsky, MD; Charles R. Rinaldo, PhD; Shirley Kwok, BS; John J. Sninsky, PhD; Phalguni Gupta, PhD; David Imagawa, PhD; Homayoon Farzadegan, PhD; Lisa P. Jacobson, ScM; Kathie S. Grovit, BS; Moon H. Lee, PhD; Joan S. Chmiel, PhD; Harold Ginzburg, MD, JD; Richard A. Kaslow, MD; and John P. Phair, MD
[+] Article, Author, and Disclosure Information

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.

© 1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;111(12):961-972. doi:10.7326/0003-4819-111-12-961
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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).





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