Antiretroviral treatment of primary HIV infection to reduce onward transmission.
OBJECTIVE
This review will discuss the role of antiretroviral therapy to treat primary HIV infection (PHI) as a strategy to prevent onward viral transmission.


RESULTS
Novel technology has greatly enhanced the appreciation of the characteristics of recently transmitted HIV-1 variants. Recent primate data demonstrate marked enhanced infectiousness of viral variants isolated from acutely infected macaques compared with viruses isolated from animals in the chronic phase of disease. These data are supported by phylogenetic analyses of recently transmitted cases in humans, implying that individuals with PHI may contribute disproportionately to onward transmission at a population level.


CONCLUSIONS
In the absence of randomized clinical trial data supporting individual benefit of antiretroviral therapy, targeting and treating individuals with PHI as a public health intervention strategy represent a paradigm shift from current treatment strategies based around proven individual benefit alone. However, there is increasing evidence that PHI contributes disproportionately to viral transmission at a population level and failure to incorporate the potential role PHI plays, particularly in focused epidemics, maybe a naïve omission of many of the current mathematical models evaluating the impact of universal test and treat on population-level HIV incidence.
Hamlyn
Elizabeth
E
GUM HIV, HIV Clinical Trials Unit, Imperial College London, London, UK.
Jones
Vicky
V
Porter
Kholoud
K
Fidler
Sarah
S
D000818:Animals; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D006678:HIV / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control* / Q000821:virology; D006801:Humans; D008962:Models, Theoretical; D010802:Phylogeny; D018419:Primate Diseases / Q000821:virology; D016097:Simian Acquired Immunodeficiency Syndrome / Q000821:virology
D044966:Anti-Retroviral Agents