Primary HIV infection

Abstract

Primary HIV infection refers to the events surrounding acquisition of HIV infection. It is associated with a nonspecific clinical syndrome that occurs 2 to 4 weeks after exposure in 40% to 90% of individuals acquiring HIV. Patients identified before seroconversion often have very high plasma HIV RNA titers that, without treatment, gradually decrease to reach a set point. Treatment of primary HIV infection with highly active antiretroviral therapy does not prevent establishment of chronic infection. However, very early therapy could potentially decrease the viral set point, prevent viral diversification, preserve immune function, improve clinical outcomes, and decrease secondary transmission. These benefits have not yet been definitely demonstrated. Transmission of viral strains with decreased susceptibility to antiviral drugs has led to recommendations for resistance testing in primary infection before initiation of therapy. Immunomodulators and vaccines are also under study as adjuvant therapy for treatment of primary HIV infection.