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A distinct entity requiring distinct counselling
Primary HIV-1 infection (PHI) has again become a hot topic in HIV research. This relates to the lack of consensus on the management of PHI, and partly because studying transmission and the events early in infection may aid the understanding of HIV-1 pathogenesis. As such, clinics are currently actively case finding PHI for participation into randomised control studies, such as the international study, SPARTAC.1 Identifying cases of PHI is also now easier because of the wider availability of improved diagnostic techniques such as proviral DNA polymerase chain reaction and the detuned antibody assay (B clade only). In addition, it is hoped that with improved public awareness of sexual health, more active HIV testing by clinics and the availability of the rapid HIV test (Pocit), more individuals will regularly test for HIV and any cases of PHI will therefore be detected more easily.
A recent article in the New England Journal of Medicine summarised the management of newly diagnosed HIV, but did not specifically mention primary infection.2 There are, however, particular issues that arise only at PHI; (i) counselling for prognosis, (ii) antiretroviral treatment, and (iii) transmission, which make it important to …
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