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Robb ML, Eller LA, Kibuuka H, Rono K, Maganga L, Nitayaphan S, Kroon E, Sawe FK, Sinei S, Sriplienchan S, Jagodzinski LL, Malia J, Manak M, de Souza MS, Tovanabutra S, Sanders-Buell E, Rolland M, Dorsey-Spitz J, Eller MA, Milazzo M, Li Q, Lewandowski A, Wu H, Swann E, O'Connell RJ, Peel S, Dawson P, Kim JH, Michael NL. Prospective Study of Acute HIV-1 Infection in Adults in East Africa and Thailand. N Engl J Med 2016; 374:2120-30. [PMID: 27192360 PMCID: PMC5111628 DOI: 10.1056/nejmoa1508952] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acute human immunodeficiency virus type 1 (HIV-1) infection is a major contributor to transmission of HIV-1. An understanding of acute HIV-1 infection may be important in the development of treatment strategies to eradicate HIV-1 or achieve a functional cure. METHODS We performed twice-weekly qualitative plasma HIV-1 RNA nucleic acid testing in 2276 volunteers who were at high risk for HIV-1 infection. For participants in whom acute HIV-1 infection was detected, clinical observations, quantitative measurements of plasma HIV-1 RNA levels (to assess viremia) and HIV antibodies, and results of immunophenotyping of lymphocytes were obtained twice weekly. RESULTS Fifty of 112 volunteers with acute HIV-1 infection had two or more blood samples collected before HIV-1 antibodies were detected. The median peak viremia (6.7 log10 copies per milliliter) occurred 13 days after the first sample showed reactivity on nucleic acid testing. Reactivity on an enzyme immunoassay occurred at a median of 14 days. The nadir of viremia (4.3 log10 copies per milliliter) occurred at a median of 31 days and was nearly equivalent to the viral-load set point, the steady-state viremia that persists durably after resolution of acute viremia (median plasma HIV-1 RNA level, 4.4 log10 copies per milliliter). The peak viremia and downslope were correlated with the viral-load set point. Clinical manifestations of acute HIV-1 infection were most common just before and at the time of peak viremia. A median of one symptom of acute HIV-1 infection was recorded at a median of two study visits, and a median of one sign of acute HIV-1 infection was recorded at a median of three visits. CONCLUSIONS The viral-load set point occurred at a median of 31 days after the first detection of plasma viremia and correlated with peak viremia. Few symptoms and signs were observed during acute HIV-1 infection, and they were most common before peak viremia. (Funded by the Department of Defense and the National Institute of Allergy and Infectious Diseases.).
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Affiliation(s)
- Merlin L Robb
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Leigh A Eller
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Hannah Kibuuka
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Kathleen Rono
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Lucas Maganga
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Sorachai Nitayaphan
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Eugene Kroon
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Fred K Sawe
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Samuel Sinei
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Somchai Sriplienchan
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Linda L Jagodzinski
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Jennifer Malia
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Mark Manak
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Mark S de Souza
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Sodsai Tovanabutra
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Eric Sanders-Buell
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Morgane Rolland
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Julie Dorsey-Spitz
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Michael A Eller
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Mark Milazzo
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Qun Li
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Andrew Lewandowski
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Hao Wu
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Edith Swann
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Robert J O'Connell
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Sheila Peel
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Peter Dawson
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Jerome H Kim
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
| | - Nelson L Michael
- From the U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring (M.L.R., L.A.E., L.L.J., J.M., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L., S.P., J.H.K., N.L.M.), Henry M. Jackson Foundation for the Advancement of Military Medicine (M.L.R., L.A.E., M. Manak, S.T., E.S.-B., M.R., J.D.-S., M.A.E., M. Milazzo, Q.L.), the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (E.S.), Bethesda, and Emmes, Rockville (A.L., H.W., P.D.) - all in Maryland; Makerere University Walter Reed Project, Kampala, Uganda (H.K.); Walter Reed Project, Kericho, Kenya (K.R., F.K.S., S. Sinei); Mbeya Medical Research Centre, Mbeya, Tanzania (L.M.); the Armed Forces Research Institute of Medical Sciences (S.N., E.K., S. Sriplienchan, M.S.S., R.J.O.) and SEARCH, Thai Red Cross AIDS Research Center (E.K., M.S.S.) - both in Bangkok, Thailand; and the International Vaccine Institute, Seoul, South Korea (J.H.K.)
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