Acute HIV Infection Dynamics and Transmission Risk
Summary
The acute phase of HIV infection encompasses the interval immediately following viral acquisition, characterised by rapid viral replication, high plasma viraemia and the absence of a mature antibody response. This period typically lasts several weeks, during which the virus disseminates systemically and establishes reservoirs in lymphoid tissues. Elevated viral loads translate into disproportionately high transmission risk per exposure, rendering this window critical for the onward spread of HIV. Detailed modelling of infectivity trajectories has revealed that heterogeneity in individual susceptibility and infectiousness can substantially influence the estimated duration and hazard of acute-phase transmission. Early detection and immediate initiation of antiretroviral therapy (ART) can dramatically reduce plasma viraemia, curtail reservoir seeding and diminish behavioural risk through counselling. Despite advances in point-of-care diagnostics and risk-scoring algorithms, barriers persist in many settings, including limited access to nucleic acid or p24 antigen testing, logistical challenges in rapid treatment initiation and variability in repeat testing uptake. Integrating symptom-based screening, targeted risk algorithms and accelerated ART pathways promises to mitigate transmission at its most infectious stage, with significant implications for prevention strategies, treatment-as-prevention programmes and epidemic control on a global scale.
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Acute HIV Infection Dynamics and Transmission Risk publication trend
The graph below shows the total number of articles in acute hiv infection dynamics and transmission risk across all publications each year (not limited to Nature Index journals).
Technical terms
Acute HIV infection: The initial period after HIV acquisition characterised by high-level viral replication, absence of detectable antibodies and elevated transmission risk.
Viral load: The concentration of HIV RNA copies per millilitre of blood plasma, used as a surrogate for infectivity and treatment response.
Antiretroviral therapy (ART): A regimen of drugs that suppress HIV replication, reduce plasma viraemia and prevent disease progression.
Seroconversion: The process by which HIV-specific antibodies become detectable in the blood, marking transition from acute to early infection phases.
p24 antigen: An HIV capsid protein that appears in blood before antibodies, enabling early detection of infection.
References
- Reassessment of HIV-1 Acute Phase Infectivity: Accounting for Heterogeneity and Study Design with Simulated Cohorts. PLOS Medicine (2015).
- Clinical and public health implications of acute and early HIV detection and treatment: a scoping review. Journal of the International AIDS Society (2017).
- Acute HIV infection detection and immediate treatment estimated to reduce transmission by 89% among men who have sex with men in Bangkok. Journal of the International AIDS Society (2017).
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