Partner characteristics predicting HIV-1 setpoint in sexually acquired HIV-1 among African seroconverters.

Publication Type:

Journal Article


AIDS research and human retroviruses, Volume 29, Issue 1, p.164-71 (2013)


2013, Center-Authored Paper, Clinical Research Division, November 2012, Public Health Sciences Division, Vaccine and Infectious Disease Division


Background: Plasma HIV-1 RNA setpoint is an important predictor of HIV-1 disease progression. We hypothesized that inoculum size and HIV-1 exposure prior to HIV-1 transmission may modulate setpoint. We evaluated predictors of setpoint among 141 African HIV-1 seroconverters and their HIV-1 infected partners. Methods: We compared characteristics of seroconverters and their HIV-1 infected partners and HIV-1 setpoint. Data were from a clinical trial of genital HSV-2 suppression with acyclovir to reduce HIV-1 transmission in HIV-1 serodiscordant couples with HIV-1 transmission linkage assigned through virus sequencing. Results: In multivariable analysis, higher plasma HIV-1 in source partners was associated with higher seroconverter setpoint (+0.44 log10 copies/mL per log10 source partner plasma HIV-1, p<0.001). In addition, bacterial vaginosis (BV) among female source partners near the time of infection was associated with higher setpoint in their male seroconverters (+0.49 log10, p=0.04). Source partner characteristics associated with lower setpoint included male circumcision (-0.63 log10, p=0.03) and assignment to acyclovir (-0.44 log10, p=0.02). The proportion of variation in setpoint explained by plasma HIV-1 RNA of the source partner, after controlling for other factors, was 0.06. Conclusions: Source partner plasma HIV-1 level is the most significant predictor of seroconverter setpoint, possibly reflecting characteristics of the transmitted virus. Acyclovir use, BV among women source partners, and circumcision among male source partners may alter setpoint by affecting transmitted virus inoculum in the source partners' genital compartment.