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Reply to Neogi et al.

To the Editor—We appreciate the comments by Neogi et al in response to our study of human immunodeficiency virus type 1 (HIV-1) subtype and plasma viremia during early infection and their perspectives on the underlying causes for the spread of HIV-1 subtype C [1]. In our multinational population of persons with incident HIV-1 infection, we found that early viremia, as measured by mean viral load and the proportion of persons with high viral loads (>5 log10 copies/mL), was similar for individuals infected with HIV-1 subtype C, compared with those infected with other common African HIV-1 subtypes [2]. Prior studies, including those by Novitsky et al [3] and Neogi et al [4], found that a substantial fraction of persons with primary subtype C infection have high-level viremia, but those studies did not have contemporaneous comparison populations. Our findings suggest that the proportion of individuals with high-level viremia in early HIV-1 infection is similar for subtype C and non-C HIV-1 infections in Africa and that high-level early viremia specific to subtype C is not likely to explain the spread of subtype C in Africa.