Role of acute and early HIV infection in the sexual transmission of HIV

Curr Opin HIV AIDS. 2010 Jul;5(4):277-82. doi: 10.1097/COH.0b013e32833a0d3a.


Purpose of review: Acute HIV infection (AHI), the earliest period after HIV acquisition, is only a few weeks in duration. In this brief period, the concentration of HIV in blood and genital secretions is extremely high, increasing the probability of HIV transmission. Although a substantial role of AHI in the sexual transmission of HIV is biologically plausible, the significance of AHI in the epidemiological spread of HIV remains uncertain.

Recent findings: AHI is diagnosed by detecting viral RNA or antigen in the blood of persons who are HIV seronegative. Depending on the setting, persons with AHI represent between 1 and 10% of persons with newly diagnosed HIV infection. The high concentration of virus during AHI leads to increased infectiousness, possibly as much as 26 times greater than during chronic infection. In mathematical models, the estimated proportion of transmission attributed to AHI has varied considerably, depending on model structure, model parameters, and the population. Key determinants include the stage of the HIV epidemic and the sexual risk profile of the population.

Summary: Despite its brief duration, AHI plays a disproportionate role in the sexual transmission of HIV infection. Detection of persons with AHI may provide an important opportunity for transmission prevention.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Blood / virology
  • Bodily Secretions / virology
  • Disease Transmission, Infectious / prevention & control
  • HIV Infections / epidemiology*
  • HIV Infections / prevention & control
  • HIV Infections / transmission*
  • Humans
  • Models, Theoretical
  • RNA, Viral / blood
  • Time Factors
  • Viral Load


  • RNA, Viral