Background: Acute HIV infection (AHI) is characterized by high viral replication and increased infectiousness. Identification of men who have sex with men (MSM) in AHI for immediate antiretroviral treatment (ART) and behavioral risk reduction counseling may be promising measures to reduce transmission.
Methods: Between April 2009 and December 2012, 58,908 specimens of subjects attending HIV testing clinics in Bangkok were screened for AHI using nucleic acid testing and sequential enzyme-immunoassay. ART was offered at baseline and subjects were counseled to reduce transmission risk. Blood HIV viral load (VL) was measured at weeks 0, 2, 4, 8, 12, 16, 20 and 24, and seminal plasma VL and anal lavage VL were measured at weeks 0, 2, 4, 12 and 24 with lower limit of detection of 50 (1.7 log (10)) copies/ml. Risk behavior was assessed by questionnaire at weeks 0 and 24.
Results: 104 subjects with AHI were identified and 84 accepted immediate ART; 76 were MSM of whom 75 remained on study. At baseline, mean age was 29 and mean duration from HIV exposure was 16 days. After ART, HIV VL in blood, seminal plasma and anal lavage declined as follows:
The percentage of MSM reporting unprotected intercourse during the past 4 months decreased from 80% at baseline to 24% at week 24; from 61% to 12% with steady partners and from 58% to 8% with casual partners (all p < 0.001). No injection drug use was reported.
Conclusion: Sharp decreases in HIV blood plasma VL, seminal plasma VL and risk behaviors were seen in this cohort of MSM with AHI after initiation of ART and risk reduction counseling. AHI detection and control may be potential HIV prevention measures to help reduce the spread of HIV in this population.
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