Role of acute and early HIV infection in the sexual transmission of HIV.
OBJECTIVE
Acute HIV infection (AHI), the earliest period after HIV acquisition, is only a few weeks in duration. In this brief period, the concentration of HIV in blood and genital secretions is extremely high, increasing the probability of HIV transmission. Although a substantial role of AHI in the sexual transmission of HIV is biologically plausible, the significance of AHI in the epidemiological spread of HIV remains uncertain.


RESULTS
AHI is diagnosed by detecting viral RNA or antigen in the blood of persons who are HIV seronegative. Depending on the setting, persons with AHI represent between 1 and 10% of persons with newly diagnosed HIV infection. The high concentration of virus during AHI leads to increased infectiousness, possibly as much as 26 times greater than during chronic infection. In mathematical models, the estimated proportion of transmission attributed to AHI has varied considerably, depending on model structure, model parameters, and the population. Key determinants include the stage of the HIV epidemic and the sexual risk profile of the population.


CONCLUSIONS
Despite its brief duration, AHI plays a disproportionate role in the sexual transmission of HIV infection. Detection of persons with AHI may provide an important opportunity for transmission prevention.
Miller
William C
WC
Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, North Carolina 27599-7030, USA.
Rosenberg
Nora E
NE
Rutstein
Sarah E
SE
Powers
Kimberly A
KA
D001769:Blood / Q000821:virology; D012634:Bodily Secretions / Q000821:virology; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D008962:Models, Theoretical; D012367:RNA, Viral / Q000097:blood; D013997:Time Factors; D019562:Viral Load
D012367:RNA, Viral