Current review and clinical management of patients with primary HIV-1 infection: limits and perspectives

Acute primary HIV-1 infection (PHI) remains underestimated or misdiagnosed in clinical practice. Meanwhile, it has been demonstrated that early therap eutic interventions with highly active antiretroviral therapy (HAART) may d elay disease progression and possibly preserve and expand the most effectiv e immune effector T-cells against HIV together with the humoral immune resp onses. Since long-life HAART is an unachievable goal due to long-term toxic ity and risk of occurrence of resistant strains due to a decreased complian ce or other still undefined host factors, preliminary data of programmed tr eatment interruption in patients treated for PHI suggest that a significant number (30-50%) could benefit from long periods off therapy. However, in m ore than half of them, the viral load will rebound, justifying that treatme nt be reinitiated. In order to reduce this proportion, new options are curr ently being investigated, including adjunctive immune therapy to HAART such as cytokines or vaccines, which could tackle the viral rebounds by increas ing HIV-specific cellular responses. An update on the management of patient s with PHI is reviewed and the limits of the current standard of care are d iscussed. (C) 2001 Editions scientifiques et medicales Elsevier SAS.