Responding with Treatment to Those Acutely Infected with HIV: No Time to Lose

Abstract

HIV infection when HIV RNA first appears in the blood, but before HIV-specific antibodies are detectable. Individuals with AHI have increased HIV transmissibility due to the increased viral load in both blood and genital secretions, making it critically important for prevention of secondary HIV transmission. While some patients with acute infection have a viral syndrome (known as acute retroviral syndrome or primary HIV), the mild and non-specific nature of acute retroviral syndrome complicates effective screening. A significant barrier to diagnosis of AHI is the non-specific nature of the signs and symptoms associated with the acute retroviral syndrome. Unless a clinician entertains the diagnosis in the differential and orders an appropriate diagnostic test, the diagnosis will be missed. It is vital to have clinicians consider AHI in young adults with fever and diffuse lymphadenopathy and that clinicians also know to include a viralspecific test and not just an HIV antibody as diagnostic tests. Methods to incorporate HIV RNA screening of all HIV antibody negative bloods for testing populations may reduce the number of missed diagnoses for AHI. Specimen pooling and nucleic acid amplification methodologies have proven to be a feasible and effective method of acute HIV infection screening of at-risk populations such as individuals seen in Sexually Transmitted Disease clinics, Emergency Departments, and at other locations where HIV testing is routinely provided or individuals at risk for HIV infection may seek care. Diagnosing AHI is of benefit at the level of the individual patient and at the level of the general public as part of HIV disease control efforts. Early HIV therapy presents a potential window of opportunity to improve immune function and slow the progression to AIDS, and more trials are underway now to determine the clinical benefits of early HIV therapy. Transmission of HIV is principally driven by the quantity of the HIV inoculum in either blood or genital secretions. This brief period of extremely high HIV viral load and uncontrolled viral replication in AHI last for less than eight weeks. Therapy with ARV can precipitously drop the serum and genital secretion viral load and potentially render the individual “non-infectious” should the viral load drop below detection.