Relationship between cell-free viraemia, antigenaemia and antibody levels in HIV-1-infected Ethiopian patients

Abstract

To determine the relationship and occurrence of cell-free viraemia, free or immune-complexed p24-antigen and p24-antibody levels in blood from HIV-1-infected patients in Ethiopia.Peripheral blood was obtained from 66 Ethiopian and 137 Swedish HIV-1-seropositive patients. Blood samples were analysed for free or immune-complex bound p24 antigen by enzyme-linked immunosorbent assay before and after acid hydrolysis of immune complexes for infectious virus in plasma and peripheral blood mononuclear cells (PBMC), and for p24-antibody levels. We compared the kinetics of viral replication of Ethiopian with Swedish isolates in vitro.Infectious virus was isolated from PBMC in 95% and from plasma in 81% of Ethiopian AIDS patients. In contrast, p24 antigen was detected in only 5% of AIDS patients from Ethiopia, compared with 76% of those from Sweden. p24-antibody levels were much higher and more persistent in Ethiopian than in Swedish subjects. The ratio between reverse transcriptase activity and p24 antigen was significantly higher in Ethiopian isolate culture than in those of the Swedish isolates.Our results show that relationships between viraemia, p24 antigenaemia and p24-antibody levels in HIV-1-infected Ethiopian patients differ from those found in comparable Swedish patients. This pattern may partly explain the differences seen in the natural course of HIV-1 infection in Ethiopia and Sweden.Researchers conducted hematologic tests on 66 HIV-1 positive adults from Ethiopia and compared the results with those of 137 HIV-1 patients in Stockholm, Sweden, to determine the incidence of cell-free viremia, free or complexed p24 antigen, and p24 antibody levels. They isolated HIV-1 from peripheral blood mononuclear cells in 95% and from plasma in 81% of the Ethiopian subjects. The corresponding percentages for the Swedish subjects were 95% and 92%. They found p24 antigen in only 5% of AIDS patients from Ethiopia (none for asymptomatic HIV-1 subjects) compared with 76% of Swedish patients (p .01). The Ethiopian subjects had significantly higher p24 antibody levels than did the Swedish subjects (85% vs. 52%; p = .008). The ratio between reverse transcriptase activity and p24 antigen concentration stood much higher in the Ethiopians than in the Swedes (7.5 vs. 3.6; p = .0019). These results suggested that the HIV-1 strains in the Ethiopian subjects resembled rapid high HIV-1 strains. In addition, the high degrees of cell-free viremia, relative lack of free or immune complexed p24 antigen, and a persistence of p24 antibody during the entire course of infection in Ethiopian HIV-1 infected subjects intimated that the interaction between HIV-1 and the Ethiopians may be different in Africa than it is in Europe and North America. The results of another study conducted by the researchers supported this conclusion. They included high levels of tumor necrosis factor-alpha and neopterin and low levels of interferon-alpha in HIV-1 positive Ethiopians.