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Author Notes:

Correspondence to Patrick Sullivan, DVM, PhD, Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, Georgia 30322, USA. Tel: +1 404 727 2038; fax: +1 866 311 8234; pssulli@emory.edu


Research Funding:

This work was supported by funding from the US National Institutes of Health (RO1: MH66767, AI23980, AI40951, AI51231, HD40125; the AIDS International Training and Research Program (AITRP) FIC D43 TW001042, and the Social & Behavioral Core of the Emory Center for AIDS Research P30 AI050409), and the International AIDS Vaccine Initiative.


  • HIV
  • seroconversion syndrome
  • set point HIV viral load

Prevalence of seroconversion symptoms and relationship to set point viral load: Findings from a subtype C epidemic, 1995-2009

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Journal Title:



Volume 26, Number 2


, Pages 175-184

Type of Work:

Article | Post-print: After Peer Review


Objective To describe symptoms, physical exam findings, and set point viral load associated with acute HIV seroconversion in a heterosexual cohort of discordant couples in Zambia. Design We followed HIV serodiscordant couples in Lusaka, Zambia from 1995–2009 with HIV testing of negative partners and symptom inventories 3-monthly, and physical examinations annually. Methods We compared prevalence of self-reported or treated symptoms (malaria syndrome, chronic diarrhea, asthenia, night sweats, and oral candidiasis) and annual physical exam [PE] findings (unilateral or bilateral neck, axillary, or inguinal adenopathy; and dermatosis) in seroconverting versus HIV-negative or HIV-positive intervals, controlling for repeated observations, age, and sex. A composite score comprised of significant symptoms and PE findings predictive of seroconversion versus HIV-negative intervals was constructed. We modeled the relationship between number of symptoms and PE findings at seroconversion and log set-point viral load [VL] using linear regression. Results 2,388 HIV-negative partners were followed for a median of 18 months; 429 seroconversions occurred. Neither symptoms nor PE findings were reported for most seroconverters. Seroconversion was significantly associated with malaria syndrome among non-diarrheic patients (adjusted odds ratio [aOR]=4.0) night sweats (aOR=1.4), and bilateral axillary (aOR = 1.6), inguinal (aOR=2.2), and neck (aOR=2.2) adenopathy relative to HIV-negative intervals. Median number of symptoms was positively associated with set-point VL (p<0.001). Conclusions Though most acute and early infections were asymptomatic, malaria syndrome was more common and more severe during seroconversion compared with HIV-negative and HIV-positive intervals. When present, symptoms and physical exam findings were non-specific and associated with higher set point viremia.

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© 2012 Lippincott Williams & Wilkins, Inc.

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