Acute HIV infection - A key link for transmission prevention

描述（由申请人提供）： 急性艾滋病毒感染（AHI）的人可能是艾滋病毒感染继续传播的主要原因，特别是在撒哈拉以南非洲。AHI，即感染和血清转化之间的时期，持续长达10-12周。在这一短暂的时间窗口内，病毒迅速复制，导致血液和生殖器分泌物中HIV RNA浓度高。因此，在无保护性交期间传播的可能性非常高。识别AHI患者并进行干预以减少进一步传播是艾滋病毒预防的一个诱人但未经证实的机会。我们提出了一个积极的艾滋病毒传播预防计划，以确定与AHI的人和干预行为和生物。我们的中心假设是，急性艾滋病毒感染者在艾滋病毒传播中起着重要作用。我们进一步假设，对急性感染者的行为和治疗干预将减少继续传播。为了解决这些假设，我们将进行一项探索性研究，辅以数学建模，以评估拟议的预防计划的潜在影响。我们建议的研究的具体目标是：1）制定一项新的方案，通过识别和告知马拉维利隆圭的急性艾滋病毒感染者来预防艾滋病毒传播，2）评估一项短期的、综合的行为和抗逆转录病毒治疗干预措施，以预防艾滋病毒在急性艾滋病毒感染者中的传播，3）使用数学建模确定干预措施的每个组成部分的潜在单独和组合影响。为了实现这些目标，我们将利用我们在马拉维利隆圭的完善基础设施。我们将利用新的和现有的技术，更快地识别AHI患者。诊断后，患者将立即随机接受标准咨询、强化行为干预或行为干预与短期抗逆转录病毒治疗（ART）相结合。行为干预是基于信息-动机-行为技能模型。ART将使用新的和有效的抗逆转录病毒药物，以迅速阻止艾滋病毒复制和限制传染性。利用这项试点研究中收集的数据，我们将使用严格的数学模型来评估预防计划对社区内流行病的潜在影响，并计划进行一项大型随机试验。急性艾滋病毒感染（AHI）是艾滋病毒感染的最早阶段，可能会以很高的速度传播艾滋病毒感染，特别是在撒哈拉以南非洲。鉴于这种重要的可能性，我们假设对急性感染者的行为和治疗干预将减少其传播。为了解决这一假设，我们将进行一项探索性研究，再加上数学建模，以检查与抗逆转录病毒治疗过程中的人与AHI的行为干预相结合的潜在影响。

DESCRIPTION (provided by applicant): Persons with acute HIV infection (AHI) may be responsible for a substantial proportion of onward transmission of HIV infection, especially in sub-Saharan Africa. AHI, the period between infection and seroconversion, lasts up to 10-12 weeks. During this brief window of time, the virus replicates rapidly, leading to high concentrations of HIV RNA in blood and genital secretions. Consequently, the probability of transmission during unprotected intercourse is very high. Identifying persons with AHI and intervening to reduce onward transmission represents a tantalizing, but unproven, opportunity for HIV prevention. We propose an aggressive HIV transmission prevention program to identify persons with AHI and intervene behaviorally and biologically. Our central hypothesis is that persons with acute HIV infection play an important role in HIV transmission. We further hypothesize that behavioral and treatment interventions in acutely infected persons will reduce onward transmission. To address these hypotheses, we will conduct an exploratory study complemented by mathematical modeling to assess the potential impact of the proposed prevention program. The specific aims of our proposed study are to: 1) Develop a novel program to prevent HIV transmission by identifying and informing persons with acute HIV infection (AHI) in Lilongwe, Malawi, 2) Evaluate a short-term, combined behavioral and antiretroviral therapy (ART) intervention to prevent HIV transmission among persons with AHI, 3) Determine the potential individual and combined impact of each component of the intervention using mathematical modeling. To achieve these aims, we will use our well-established infrastructure in Lilongwe, Malawi. We will take advantage of new and existing technologies to identify people with AHI more rapidly. Immediately after diagnosis, persons will be randomized to standard counseling, an intensive behavioral intervention, or the behavioral intervention combined with short term antiretroviral therapy (ART). The behavioral intervention is based on the Information-Motivation- Behavioral Skills Model. The ART will use new and potent antiretroviral drugs to rapidly block HIV replication and limit infectiousness. Using the data collected in this pilot study, we will use rigorous mathematical modeling to assess the potential impact of the prevention program on the epidemic within a community and plan a large randomized trial. Persons with acute HIV infection (AHI), the earliest stage of HIV infection, may transmit HIV infection at a high rate, especially in sub-Saharan Africa. Given this important possibility, we hypothesize that behavioral and treatment interventions in acutely infected persons will reduce their transmission. To address this hypothesis, we will conduct an exploratory study, coupled with mathematical modeling, to examine the potential impact of combining a behavioral intervention with a course of antiretroviral treatment in persons with AHI.