COMMENTARY

Update: Guideline for the Treatment and Management of Acute HIV Infection

Samuel T. Merrick, MD

Disclosures

October 14, 2015

In This Article

The Medical Care Criteria Committee of the New York State Department of Health AIDS Institute has released an important update to its guideline "Diagnosis and Management of Acute HIV Infection". Specifically, the revised guideline includes a recommendation to start antiretroviral therapy (ART) in all patients at the time of diagnosis of HIV infection, as well as updated recommendations for diagnosing acute HIV.

the known and potential benefits of starting ART at the time of diagnosis outweigh the known risks

On the basis of accumulating data on the pathogenesis of acute HIV infection[1,2] and data from key studies on treatment and prevention,[3,4] the committee has concluded that the known and potential benefits of starting ART at the time of diagnosis outweigh the known risks. Strong evidence supports initiation of ART during acute infection to reduce the size of the viral reservoir,[5,6,7,8] prevent or reduce disruption of gut tissue,[9,10] preserve immune function,[11,12,13] suppress virus to undetectable levels in the plasma more rapidly,[14] and potentially reduce morbidity in those with symptomatic acute infection, a group known to be at higher risk for progression.[15,16,17] All of these treatment effects can be reasonably expected to provide both short- and long-term clinical benefits for the patient.

There is also strong evidence that reduced plasma viremia correlates with a reduction in transmission. Randomized controlled trials have demonstrated nearly full protection from HIV transmission among serodiscordant heterosexual couples.[4,18,19]

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