Management of Acute and Early HIV-1 Infection

The identification of patients with acute HIV infection provides an unequalled opportunity to give access to medical care and educational materials to a population of patients who may not otherwise seek medical care for several years.These interventions would, in turn, likely reduce secondary transmission. This review provides a discussion of the theoretical advantages and disadvantages of immediate antiretroviral therapy for primary HIV infection. Overall, patient commitment is the main factor for treatment decisions, because results from clinical trials indicate that, with the presently available drugs, a lifelong treatment has to be env i s aged and that non-adherence is observed in approximately 30% of patients enrolled in clinical trials. An increase in the incidence of transmission of drug-resistant HIV variants and the diversity of HIV subtypes among new ly infected individuals in recent years may limit the available therapeutic options. More potent and simpler drug therapies, with less long-term toxicity, strategies to decrease the latent HIV reservoir, detection of drug resistance, and strategies to improve patient adherence are all important elements in the management of patients with acute and early HIV infection.