Acute and early HIV infection: Treatment
- Paul E Sax, MD
Paul E Sax, MD
- Section Editor — HIV
- Clinical Director, Division of Infectious Diseases
- Brigham and Women's Hospital
- Professor of Medicine
- Harvard Medical School
The first description of acute HIV infection, a "mononucleosis-like" illness, based upon the clinical records of 12 men with documented seroconversion to HIV during the preceding six months, was published in 1985 . Since then, the early period following acquisition of HIV has been a subject of tremendous clinical and research interest, yet many challenges remain in its diagnosis, management, and impact on public health.
Difficulties in identifying patients with early HIV infection have hindered the performance of trials to evaluate the long-term clinical benefits of initiation of antiretroviral therapy during this stage of infection. Thus, decisions for treatment initiation during this period must balance the potential benefits based on indirect evidence, including effects on surrogate markers, and the potential risks of earlier therapy. In addition, the general trend in treatment guidelines in favor of treating all individuals with HIV infection influences the approach in early infection toward treatment .
The treatment of early HIV infection will be reviewed here. The pathogenesis, epidemiology, clinical manifestations, and diagnosis of acute and early infection with HIV are discussed separately. (See "Acute and early HIV infection: Pathogenesis and epidemiology" and "Acute and early HIV infection: Clinical manifestations and diagnosis".)
Different terms, including acute, recent, primary, and early HIV infection, have been used in the literature to refer to variable intervals following initial infection with the virus. In this topic, we use the term "early HIV infection" to refer to the approximate six-month period following HIV acquisition. We use the term "acute HIV infection," to refer to symptomatic early infection, as this reflects common usage in clinical care.
DECISION TO INITIATE ANTIRETROVIRAL THERAPY DURING EARLY HIV INFECTION
For chronically infected HIV patients, a growing body of evidence from trials and large observational studies that demonstrate a reduction in AIDS and non-AIDS morbidity and mortality with antiretroviral therapy (ART) across a wide range of CD4 cell counts has led to the recommendation by many experts for ART initiation regardless of CD4 cell count. (See "When to initiate antiretroviral therapy in HIV-infected patients", section on 'Benefits of antiretroviral therapy'.)
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- DECISION TO INITIATE ANTIRETROVIRAL THERAPY DURING EARLY HIV INFECTION
- Rationale for initiation of ART in early infection
- - Effect on symptomatic disease
- - Improved clinical markers of disease
- - Interval until treatment criteria are met is short
- - Decreased risk of transmission
- - Decreased viral reservoir and improved markers of immune cell function
- Potential risks
- Recommendations from expert groups
- Our approach
- MANAGEMENT OF EARLY HIV INFECTION
- Patients who initiate antiretroviral therapy
- - Treatment setting
- - Selection of antiretroviral regimen
- - Monitoring during antiretroviral therapy
- - Duration of treatment
- Patients who defer antiretroviral therapy
- CAN ART IN EARLY INFECTION ALTER DISEASE COURSE?
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS