Benefits of antiretroviral therapy initiation during acute HIV infection

ABSTRACT

Objectives: In the last decade, there has been increasing scientific and legislative focus on antiretroviral treatment (ART) for all people living with HIV. Especially early ART initiation, preferably during acute HIV infection, has been named as a promising strategy, both for the individual and for the society. This article will review the benefits and possible future applications of immediate ART initiation during acute HIV infection and explore the remaining hurdles towards this strategy.

Results: On an individual level, initiation of ART during acute HIV infection limits the viral reservoir, preserves immune function, and decreases systemic inflammation. In addition, obtaining viral suppression soon after infection can be beneficial for the society by decreasing the chance of onward HIV transmission. Reducing the transmission will reduce HIV incidence and can curtail HIV-related health expenditure. Furthermore, the favorable immunological and virological profile obtained by treating during acute HIV infection will form an ideal starting point for several HIV cure strategies.

Conclusions: Initiation of ART during acute HIV infection has shown distinct benefits for the individual, for the society, and for future research on HIV cure. In order to implement this strategy, equal focus should be placed on early diagnosis.

KEYWORDS:

• Acute HIV infection
• acute retroviral syndrome
• early antiretroviral therapy
• treatment as prevention
• HIV cure

Acknowledgments

We would like to thank Basiel Cole and Tinus Schynkel for their critical review of this manuscript.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This work was supported by the Bijzonder Onderzoeksfonds [01D22019]; Fonds Wetenschappelijk Onderzoek [FWO 1.8.020.09.N.00]; Fonds Wetenschappelijk Onderzoek [FWO 1S32916N].