Quantitation of human immunodeficiency virus type 1 in the blood of infected persons

• Published in: The New England journal of medicine Vol. 321; no. 24; p. 1621
• Main Authors: Ho, D D, Moudgil, T, Alam, M
• Format: Journal Article
• Language: English
• Published: United States 14-12-1989
• Subjects: Acquired Immunodeficiency Syndrome - drug therapy; Acquired Immunodeficiency Syndrome - microbiology; AIDS-Related Complex - drug therapy; AIDS-Related Complex - microbiology; Blood - microbiology; Cytopathogenic Effect, Viral; Female; HIV-1 - isolation & purification; Humans; Leukocytes, Mononuclear - microbiology; Male; Viremia - microbiology; Zidovudine - therapeutic use
• ISSN: 0028-4793
• DOI: 10.1056/NEJM198912143212401

We used end-point-dilution cultures to measure the level of infectious human immunodeficiency virus type 1 (HIV-1) in peripheral-blood mononuclear cells (PBMC) and plasma of 54 infected patients who were not receiving antiviral chemotherapy. HIV-1 was recovered from the plasma and PBMC of every seropositive patient, but from none of 22 seronegative control subjects. The mean titers in plasma were 30, 3500, and 3200 tissue-culture-infective doses (TCID) per milliliter for patients with asymptomatic infection, the acquired immunodeficiency syndrome (AIDS), and the AIDS-related complex, respectively. In PBMC, the mean titers were significantly higher for symptomatic patients (AIDS, 2200, and AIDS-related complex, 2700 TCID per 10(6) PBMC) than asymptomatic patients (20 TCID per 10(6) PBMC). The values for the symptomatic patients were considered to indicate that at least 1 in 400 circulating mononuclear cells harbored HIV-1. The HIV-1 titers of seven patients with AIDS or AIDS-related complex treated with zidovudine for four weeks decreased significantly in plasma but not in PBMC. In addition, the mean titer in the plasma of 20 patients receiving long-term zidovudine treatment (130 TCID per milliliter) was 25-fold lower than the mean for comparable untreated patients with AIDS or AIDS-related complex. We conclude that the levels of HIV-1 in plasma and PBMC are much higher than previous estimates. This high degree of HIV-1 viremia raises the possibility that the direct cytopathic effect of this retrovirus alone may be sufficient to explain much of the pathogenesis of AIDS.