Initiation of antiretroviral therapy during acute HIV-1 infection leads to a high rate of nonreactive HIV serology

Mark S. De Souza*, Suteeraporn Pinyakorn, Siriwat Akapirat, Supanit Pattanachaiwit, James L.K. Fletcher, Nitiya Chomchey, Eugene D. Kroon, Sasiwimol Ubolyam, Nelson L. Michael, Merlin L. Robb, Praphan Phanuphak, Jerome H. Kim, Nittaya Phanuphak, Jintanat Ananworanich, Nipat Teeratakulpisarn, Donn Colby, Duanghathai Sutthichom, Somprartthana Rattanamanee, Peeriya Prueksakaew, Pacharin EamyoungSuwanna Puttamaswin, Somporn Tipsuk, Putthachard Karnsomlap, Rapee Trichavaroj, Bessara Nuntapinit, Pornchanok Panjapornsuk, Bhubate Tongchanakarn, Wanwarang Kobchit, Viseth Ngauy, Robert O'Connell, Nantana Tantibul, Hathairat Savadsuk, Vatcharain Assawadarachai, Sodsai Tovanabutra

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

96 Scopus citations


Background. Third- and fourth-generation immunoassays (IAs) are widely used in the diagnosis of human immunodeficiency virus (HIV) infection. Antiretroviral therapy (ART) during acute HIV infection (AHI) may impact HIV-specific antibodies, with failure to develop antibody or seroreversion. We report on the ability of diagnostic tests to detect HIV-specific antibodies in Thai participants initiating ART during AHI. Methods. Participants with detectable plasma HIV RNA but nonreactive HIV-specific immunoglobulin G, enrolled in an AHI study, were offered immediate initiation of ART. Participants were tested at initiation and at 12 and 24 weeks following treatment using standard second-, third-, and fourth-generation IAs and Western blot (WB). Results. Participants (N = 234) initiating ART at a median of 19 days (range, 1-62 days) from HIV exposure demonstrated different frequencies of reactivity prior to and following 24 weeks of ART depending on the IA. Third-generation IA nonreactivity prior to ART was 48%, which decreased to 4% following ART (P <. 001). Fourth-generation IA nonreactivity was 18% prior to ART and 17% following ART (P =. 720). Negative WB results were observed in 89% and 12% of participants prior to and following 24 weeks of ART, respectively (P <. 001). Seroreversion to nonreactivity during ART was observed to at least one of the tests in 20% of participants, with fourth-generation IA demonstrating the highest frequency (11%) of seroreversion. Conclusions. HIV-specific antibodies may fail to develop and, when detected, may decline when ART is initiated during AHI. Although fourth-generation IA was the most sensitive at detecting AHI prior to ART, third-generation IA was the most sensitive during treatment. Clinical Trials Registration. NCT00796146 and NCT00796263.

Original languageEnglish
Pages (from-to)555-561
Number of pages7
JournalClinical Infectious Diseases
Issue number4
StatePublished - 15 Aug 2016
Externally publishedYes


  • Acute HIV infection
  • Bangkok
  • HIV-1
  • Immunoassay
  • Seroreversion


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