Primary HIV Infection

Abstract

Primary human immunodeficiency virus (HIV) infection defines a brief period soon after inoculation with HIV that is characterised by intense viraemia, a subsequent immune response and, in the majority of patients, a brief, febrile illness [17]. Understanding the immune response during primary HIV infection has improved our insight in the two-way interaction between HIV and the immune system. Evolution in molecular diagnostics has transformed the speed and accuracy of diagnosing HIV infection, although the most appropriate diagnostic algorithm has not been defined. Zidovudine monotherapy initiated during primary HIV infection confers modest clinical benefit [55]. Preliminary reports now suggest that combination antiretroviral therapy of primary HIV infection is safe, tolerated and far more effective in suppressing viral replication [47,65,73] and results in greater preservation of immune function [83]. The clinical impact of early combination therapy, however, is unknown. Whether such therapy can eradicate HIV or is more effective than delayed therapy is currently under investigation. Because there are minimal data on primary HIV-2 infection, only primary HIV-1 infection is considered in this review; nevertheless, the same biological, diagnostic and therapeutic principles would apply.