HIV Highly Transmittable Through Sexual Intercourse During Primary Infection Asymptomatic Period
HIV is "readily transmitted by sexual intercourse" during primary HIV infection (PHI), according to study results outlined by Dr. Christopher Pilcher of the University of North Carolina School of Medicine and colleagues in a research letter to the Journal of the American Medical Association. Some researchers have theorized that peak viremia during PHI is associated with "high-level" genital viral shedding, increasing the odds of HIV transmission. In this study, the researchers reviewed five cases from four university hospital clinics in which sexual transmission of HIV from one individual with documented PHI to another person who later developed documented PHI occurred. PHI was defined as p24 antigen positivity, RNA and/or DNA positivity, enzyme-linked immunosorbent assay negativity or two or fewer bands on a Western blot test within 30 days. Two of the couples reported a single sexual exposure two days before onset of symptoms in the transmitting partner and a week before onset of symptoms in the transmitting partner respectively. Another couple reported a single exposure seven days after the transmitter's first symptoms appeared, while two couples reported "frequent, regular intercourse." However, one of those couples reported that all of the exposures occurred prior to two days after the onset of symptoms in the transmitting partner. The researchers concluded that HIV can be transmitted sexually up to seven days before the transmitter has experienced any symptoms of primary HIV infection. These exposures would account for the "rapid epidemic spread in populations and would suggest that PHI is an important target for public health interventions," the authors state. Both the transmitting partner and the infected partner can be identified by "urgently" tracking recent sexual partners and secondary transmission risk can be reduced for all of those infected through counseling, antiretroviral therapy and/or treatment for other STDs, they conclude (Pilcher et al., JAMA, 10/10).This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.