Recent issues in primary HIV: from diagnosis to oral sex transmission

Frederick M. Hecht, MD

Summary by Tim Horn

Edited by James Koopman, MD; Martin Markowitz, MD

Thanks to sweeping improvements in the identification and clinical management of HIV among virtually all risk groups in the United States, HIV-infected people are now being diagnosed and receiving care earlier than their counterparts a decade earlier. However, most patients are still being diagnosed after one of the most unique and clinically crucial stages of HIV disease – primary HIV infection (PHI) – has come and gone.

Unlike the relatively slow progression rate associated with chronic HIV infection, PHI – loosely defined as the brief period after HIV first enters the body – involves an awesome display of immune activity, high viral levels, and, in some cases, symptomatic disease. At the same time, many experts suggest that PHI is a unique window of opportunity with respect to treatment, since it may be the optimal time to initiate HAART to alter the long-term course of HIV disease (see sidebar). On a public-health level, correct diagnosis and medical intervention during PHI – a period in which viral load is exceptionally high – may be useful in halting the unintentional spread of the virus when someone is at his or her most “infectious.”

The Options Project, developed and run by the University of California, San Francisco (UCSF) AIDS Program at San Francisco General Hospital, is dedicated to the study of PHI clinical management. Dr. Frederick Hecht, a co-director of the program, and his colleagues have made significant headway in addressing three thorny PHI-related issues: the risk of HIV transmission through oral sex; the diagnosis of PHI in patients who have not yet seroconverted; and the transmission of drug-resistant HIV strains.

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