Abstract
Individuals in the acute stage of HIV infection (AHI) have an elevated potential to transmit HIV and play a critical role in the growth of the epidemic. Routine identification and counseling of individuals during AHI could decrease transmission behavior during this key period. However, diagnosis of AHI may present challenges distinct from those experienced through diagnosis of established HIV infection. A study was conducted in a public youth clinic outside of Cape Town, South Africa, to identify and counsel individuals with acute stage HIV infection. In-depth interviews were conducted with patients following diagnosis. After counseling, patients were accepting of the testing regimen used to diagnose AHI. They used the knowledge of having been recently infected to identify the source of their infection, but did not retain or place importance on information regarding the increased ability to transmit HIV during the acute stage. Future interventions directed at the reduction of HIV transmission following diagnosis with AHI will need to find ways of making this information more salient, possibly through more culturally meaningful educational approaches.
Highlights
Individuals in the acute stage of HIV infection (AHI) have an elevated potential to transmit HIV and play a critical role in the growth of the epidemic
Patients who present for testing during the acute stage often remain unaware of their HIV infection, even as they experience a temporary period of elevated infectiousness [1,4,5]
Since acutely infected individuals will test negative on a rapid antibody test and positive on nucleic acid amplification testing (NAAT), there is the potential for confusion or mistrust of the seemingly contradictory results
Summary
Individuals in the acute stage of HIV infection (AHI) have an elevated potential to transmit HIV and play a critical role in the growth of the epidemic. Since acutely infected individuals will test negative on a rapid antibody test and positive on NAAT, there is the potential for confusion or mistrust of the seemingly contradictory results. Those who do become aware of their HIV infection during the acute phase will know that they were recently infected and that they are in a period of temporarily elevated infectiousness. How this information might be understood and interpreted is unclear. It is concerning in the context of the known potential for HIV positive status disclosure to provoke violent reactions towards women, well described in the antenatal settings [6]
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