Abstract
Primary HIV-1 infection represents the time when the virus is first disseminating throughout the body and induces host immune responses. Diagnosing this stage of disease requires an understanding of who is at risk, the clinical manifestations of primary infection, and how the diagnosis is made. Identifying these individuals allows for counseling to prevent further transmission to others and the potential benefits associated with early antiretroviral therapy. Moreover, studying these individuals provides important insight into the biology of HIV-1 transmission and immunopathogenesis.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References and Recommended Reading
Vanhems P, Dassa C, Lambert J, et al.: Comprehensive classification of symptoms and signs reported among 218 patients with acute HIV-1 infection. J Acquir Immune Defic Syndr 1999, 21:99–106.
Daar ES, Little SJ, Pitt J, et al.: Diagnosing primary HIV infection. Ann Intern Med 2001, 134:25–29.
Dorrucci M, Rezza G, Vlahov D, et al.: Clinical characteristics and prognostic value of acute retroviral syndrome among injecting drug users. AIDS 1995, 9:597–604.
Hecht FM, Busch MP, Rawal B0, et al.: Use of laboratory tests and clinical symptoms for identification of primary HIV infection. AIDS 2002, 24:1119–1129.
Karon JM, Fleming PL, Steketee RW, De Cock KM: HIV in the United States at the turn of the century: an epidemic in transition. Am J Public Health 2001, 91:1060–1068.
Rottingen JA, Cameron DW, Garnett GP: A systematic review of the epidemiologic interactions between classic sexually transmitted diseases and HIV: how much really is known? Sex Trans Dis 2001, 28:579–597.
Richters J, Grulich A, Ellard J, et al.: HIV transmission among gay men through oral sex and other uncommon routes: case series of HIV seroconverters, Sydney. AIDS 2003, 17:2269–2271.
Xiridou M, Geskus R, de Wit J, et al.: Primary HIV infection as source of HIV transmission within steady and casual partnerships among homosexual men. AIDS 2004, 18:1311–1320. This study provides modeled data that suggest that primary infection plays a substantial role in transmission in those with casual relationships. These data emphasize the importance of identifying those with primary infection to prevent further spread of HIV.
Weintrob AC, Giner J, Menezes P, et al.: Infrequent diagnosis of primary human immunodeficiency virus infection: missed opportunities in acute care settings. Arch Intern Med 2003, 163:2097–2100.
Fiebig E, Wright D, Rawal B, et al.: Dynamics of HIV viremia and antibody seroconversion in plasma donors: implications for diagnosis and staging of primary HIV infection. AIDS 2003, 17:1871–1879. This represents one of the premiere studies that demonstrates the relationship between time since infection and the presence of various virologic and immunologic markers of HIV-1 infection.
Pilcher CD, McPherson JT, Leone PA, et al.: Real-time, universal screening for acute HIV infection in a routine HIV counseling and testing population. JAMA 2002, 288:216–221.
Burchell AN, Calzavara L, Ramuscak N, et al.: Symptomatic primary HIV infection or risk experiences? Circumstances surrounding HIV testing and diagnosis among recent seroconverters. Int J STD AIDS 2004, 14:601–608.
Constantine NT, Sill AM, Jack N, et al.: Improved classification of recent HIV-1 infection by employing a two-stage sensitive/less-sensitive test strategy. J Acquir Immune Defic Syndr 2003, 32:94–103.
Geijtenbeek TB, van Kooyk Y: DC-SIGN: a novel HIV receptor on DCs that mediates HIV-1 transmission. Curr Top Microbiol Immunol 2003, 276:31–54.
Delwart E, Magierowska M, Royz M, et al.: Homogeneous quasispecies in 16 out of 17 individuals during very early HIV-1 primary infection. AIDS 2002, 16:189–195.
Sagar M, Lavreys L, Baeten JM, et al.: Infection with multiple human immunodeficiency virus type 1 variants is associated with faster disease progression. J Virol 2003, 77:12921–12926.
Weinstock HS, Zaidi I, Heneine W, et al.: The epidemiology of antiretroviral drug resistance among drug-naive HIV-1-infected persons in 10 US cities. J Infect Dis 2004, 189:2174–2180.
Blower SM, Aschenbach AN, Kahn JO: Predicting the transmission of drug-resistant HIV: comparing theory with data. Lancet Infect Dis 2003, 3:10–11.
Little SJ, Holte S, Routy JP, et al.: Antiretroviral-drug resistance among patients recently infected with HIV. N Engl J Med 2002, 347:385–394.
Barbour JD, Hecht FM, Wrin T, et al.: Persistence of primary drug resistance among recently HIV-1 infected adults. AIDS 2004, 18:1683–1689.
Hirsch MS, Brun-Vezinet F, Clotet B, et al.: Antiretroviral drug resistance testing in adults infected with human immunodeficiency virus type 1: 2003 recommendations of an International AIDS Society-USA Panel. Clin Infect Dis 2003, 37:113–128.
US Department of Health and Human Services Panel of Clinical Practices for Treatment of HIV Infection: Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. http://www.aidsinfo.nih.gov. Accessed October 29, 2004.
Koup RA, Safrit JT, Cao Y, et al.: Temporal association of cellular immune responses with the initial control of viremia in primary human immunodeficiency virus type 1 syndrome. J Virol 1994, 68:4650–4655.
Musey L, Hughes J, Schacker T, et al.: Cytotoxic-T-cell responses, viral load, and disease progression in early human immunodeficiency virus type 1 infection. N Engl J Med 1997, 337:1267–1274.
Oxenius A, Price DA, Trkola A, et al.: Loss of viral control in early HIV-1 infection is temporally associated with sequential escape from CD8+ T cell responses and decrease in HIV-1-specific CD4+ and CD8+ T cell frequencies. J Infect Dis 2004, 190:713–721.
Richman DD, Wrin T, Little SJ, Petropoulos CJ: Rapid evolution of the neutralizing antibody response to HIV type 1 infection. Proc Natl Acad Sci USA 2003, 100:4144–4149.
Montefiori DC, Altfeld M, Lee PK, et al.: Viremia control despite escape from a rapid and potent autologous neutralizing antibody response after therapy cessation in an HIV-1-infected individual. J Immunol 2003, 170:3906–3914.
Forthal DN, Landucci G, Daar ES: Antibody from patients with acute human immunodeficiency virus (HIV) infection inhibits primary strains of HIV type 1 in the presence of natural-killer effector cells. J Virol 2001, 75:6953–6961.
Abdelwahab SF, Cocchi F, Bagley KC, et al.: HIV-1-suppressive factors are secreted by CD4+ T cells during primary immune responses. Proc Natl Acad Sci USA 2003, 100:15006–15010.
Blattner WA, Ann Oursler K, Cleghorn F, et al.: Rapid clearance of virus after acute HIV-1 infection: correlates of risk of AIDS. J Infect Dis 2004, 189:1793–1801.
Rosenberg ES, Billingsley JM, Caliendo AM, et al.: Vigorous HIV-1-specific CD4+ T cell responses associated with control of viremia. Science 1997, 278:1447–1450.
Gloster SE, Newton P, Cornforth D, et al.: Association of strong virus-specific CD4 T cell responses with efficient natural control of primary HIV-1 infection. AIDS 2004, 18:749–755.
Rosenberg ES, Altfeld M, Poon SH, et al.: Immune control of HIV-1 after early treatment of acute infection. Nature 2000, 407:523–526.
Kinloch-De Loes S, Hirschel BJ, Hoen B, et al.: A controlled trial of zidovudine in primary human immunodeficiency virus infection. N Engl J Med 1995, 333:408–413.
Smith D, Walker B, Cooper D, et al.: Is antiretroviral treatment of primary HIV infection clinically justified on the basis of current evidence? AIDS 2004, 18:709–718. This is a comprehensive overview of the rationale and experience in treating those identified with primary HIV-1 infection.
Miller J, Carr A, Smith DK, et al.: Lipodystrophy following antiretroviral therapy of primary HIV infection. AIDS 2000, 14:2406–2407.
Daar ES, Bai J, Hausner MA, et al.: Acute syndrome following discontinuation of antiretroviral therapy in a patient treated prior to seroconversion. Ann Intern Med 1998, 128:827–829.
Tremblay CL, Hicks JL, Sutton L, et al.: Antiretroviral resistance associated with supervised treatment interruptions in treated acute HIV infection. AIDS 2003, 17:1086–1089.
Crepaz N, Hart TA, Marks G: Highly active antiretroviral therapy and sexual risk behavior: A meta-analytic review. JAMA 2004, 292:224–236.
Lisziewicz J, Rosenberg E, Lieberman J, et al.: Control of HIV despite the discontinuation of antiretroviral therapy. N Engl J Med 1999, 340:1683–1684.
Kaufmann DE, Lichterfeld M, Altfeld M, et al.: Limited durability of viral control following treated acute HIV infection. Plos Med 2004, 1:137–147.
Rizzardi GP, Harari A, Capiluppi B, et al.: Treatment of primary HIV-1 infection with cyclosporin A coupled with highly active antiretroviral therapy. J Clin Invest 2002, 109:681–688.
Martinez-Marino B, Ashlock BM, Shiboski S, et al.: Effect of IL-2 therapy on CD8+ cell noncytotoxic anti-HIV response during primary HIV-1 infection. J Clin Immunol 2004, 24:135–144.
Markowitz M, Jin X, Hurley A,et al.: Discontinuation of antiretroviral therapy commenced early during the course of human immunodeficiency virus type 1 infection, with or without adjunctive vaccination. J Infect Dis 2002, 186:634–643.
Yeni PG, Hammer SM, Hirsch MS, et al.: Treatment for adult HIV infection: 2004 recommendations of the International AIDS Society-USA Panel. JAMA 2004, 292:251–265.
British HIV Association guidelines for the treatment of HIV disease with antiretroviral therapy. http://www.bhiva.org/ guidelines/2003/hiv/index.html. Accessed October 29, 2004.
European guidelines for the clinical management and treatment of HIV-infected adults in Europe. AIDS 2003, 17:S3-S26.
Schiffer V, Deveau C, Meyer L, et al.: Recent changes in the management of primary HIV infection: results from the French PRIMO Cohort. HIV Med 2004, 5:326–333.
Smith D, Berrey MM, Robertson M, et al.: Virological and immunological effects of combination antiretroviral therapy with zidovudine, lamivudine, and indinavir during primary human immunodeficiency virus type 1 infection. J Infect Dis 2000, 182:950–954.
Portsmouth S, Imami N, Pires A, et al.: Treatment of primary HIV-1 infection with nonnucleoside reverse transcriptase inhibitor-based therapy is effective and well tolerated. HIV Med 2004, 5:26–29.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Soogoor, M., Daar, E.S. Primary HIV-1 infection: Diagnosis, pathogenesis, and treatment. Curr Infect Dis Rep 7, 147–153 (2005). https://doi.org/10.1007/s11908-005-0075-0
Issue Date:
DOI: https://doi.org/10.1007/s11908-005-0075-0