title: Lessons from acute HIV infection.
abstract: Understanding the characteristics of transmission during acute HIV infection (AHI) may inform targets for vaccine-induced immune interdiction. Individuals treated in AHI with a small HIV reservoir size may be ideal candidates for therapeutic HIV vaccines aiming for HIV remission (i.e. viremic control after treatment interruption).
  
  
  
  The AHI period is brief and peak viremia predicts a viral set point that occurs 4-5 weeks following infection. Robust HIV-specific CD8 T-cell responses lower viral set points. Phylogenetic analyses of founder viruses demonstrated unique bottleneck selections and specific genetic signatures to optimize for high-fitness variants and successful transmission events. HIV clades, route of transmission and the presence of minor variants may affect vaccine protection. Antiretroviral treatment in AHI results in smaller HIV reservoir size, better CD4 T-cell recovery and fewer virus escapes.
  
  
  
  The knowledge of untreated and treated AHI informs the development of vaccines, in that preventive vaccines will require broad coverage for multiple clades and antigenic variants associated with unique bottleneck selections. Vaccines that help the host to control viremia could minimize onward transmission. Therapeutic HIV vaccines aimed at HIV remission should be studied in early-treated individuals who have few or no viral escape mutants and a more preserved immune system.
authors.affiliation: aU.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver SpringbHenry M. Jackson Foundation for The Advancement of Military Medicine, Bethesda, Maryland, USA.
authors.forename: Merlin L
authors.initials: ML
authors.lastname: Robb
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
mesh_terms: D016915:AIDS Vaccines / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D015658:HIV Infections / Q000276:immunology* / Q000517:prevention & control / Q000628:therapy / Q000821:virology*; D006801:Humans; D019562:Viral Load
chemical_list: D016915:AIDS Vaccines; D044966:Anti-Retroviral Agents