Should We Treat Acute HIV Infection?

• Human immunodeficiency virus infections
• Acute disease
• Anti-HIV agents
• Antiretroviral therapy, highly active
• Time factors

Whether it is prudent to treat acute or primary HIV infection aggressively with the currently available potent (and toxic) antiretroviral drugs cannot be determined until more evidence documenting the long-term benefits of the strategy “hit hard, hit very early” has accumulated. As clinical researchers have indicated regarding this situation, such evidence will become available only if newly infected persons are identified by their physicians and offered the opportunity to participate in studies investigating the basic science and clinical aspects of acute HIV infection. Currently, aggressive treatment during acute infection, while promising, is still experimental.

Interestingly, the numerous scientific unknowns surrounding the question of whether or not it is appropriate to treat acute HIV infection aggressively are now taking a back seat to the issue of diagnosis. In a recent Annals editorial, Timothy Flanigan, MD, and Karen T. Tashima, MD, of Brown University in Providence, Rhode Island, chastised the medical profession for relegating the diagnosis of acute HIV infection to specialists: “Patients with primary HIV infection most often present to non–HIV specialists … with mononucleosis-like symptoms. … Rather than considering acute HIV infection and ordering the appropriate tests, the clinician often refers the patient to a specialist in some other building and some other part of town. More often than not, the patient never gets there” (Ann Intern Med. 2001;134:75-7).