title: The HIV treatment cascade in acutely infected people: informing global guidelines.
abstract: OBJECTIVE
  Acute and early HIV (AHI) is a pivotal time during HIV infection, yet there remain major shortfalls in diagnosis, linkage to care, and antiretroviral therapy (ART) initiation during AHI. We introduce an AHI-specific cascade, review recent evidence pertaining to the unique challenges of AHI, and discuss strategies for improving individual and public health outcomes.
  
  
  RESULTS
  Presentation during AHI is common. Expanding use of fourth-generation testing and pooled nucleic acid amplification testing has led to improved AHI detection in resource-wealthy settings. Technologies capable of AHI diagnosis are rare in resource-limited settings; further development of point-of-care devices and utilization of targeted screening is needed. Rapid ART initiation during AHI limits reservoir seeding, preserves immunity, and prevents transmission. Reporting of AHI cascade outcomes is limited, but new evidence suggests that impressive rates of diagnosis, linkage to care, rapid ART initiation, and viral suppression can be achieved.
  
  
  CONCLUSIONS
  With advancements in AHI diagnostics and strong evidence for the therapeutic and prevention benefits of ART initiated during AHI, improving AHI cascade outcomes is both crucial and feasible. HIV guidelines should recommend diagnostic algorithms capable of detecting AHI and prescribe rapid, universal ART initiation during AHI.
authors.affiliation: aDepartment of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA bDivision of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA cU.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring dHenry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland eDepartment of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA *Sarah E. Rutstein and Christopher J. Sellers contributed equally to the writing of this article.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Rutstein
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sellers
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
authors.forename: Myron S
authors.initials: MS
authors.lastname: Cohen
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D019049:Developed Countries; D003906:Developing Countries; D003955:Diagnostic Tests, Routine / Q000379:methods; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D042241:Early Diagnosis; D014943:Global Health; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D006291:Health Policy; D006801:Humans; D055502:Secondary Prevention
chemical_list: D044966:Anti-Retroviral Agents