Información del artículo
Según la Organización Mundial de la Salud (OMS) cada día se infectan en el mundo unas 14.000 personas. Sin embargo, en pocos casos el diagnóstico se realizará durante la fase aguda de la infección por el virus de la inmunodeficiencia humana (VIH). La infección aguda por el VIH es el período comprendido entre la entrada del VIH en el organismo y la seroconversión completa, definida por una prueba de Western blot positiva. Este período dura aproximadamente 30 días y la mayoría de veces (40-90%) se acompaña de manifestaciones clínicas banales (fiebre, exantema, faringitis, úlceras en mucosas entre otras), de 2 semanas de duración, que se pueden confundir con otros procesos infecciosos comunitarios, entre ellos la mononucleosis infecciosa. El diagnóstico microbiológico se realiza por la ausencia de anticuerpos en plasma (prueba de análisis de inmunoabsorción ligado a enzimas [ELISA] negativa) y la presencia de una carga viral (CV) del VIH en plasma positiva (> 10.000 copias/ml). El diagnóstico de la infección aguda por el VIH es muy importante por varias razones: a) epidemiológicas, es el período con las mayores tasas de transmisión de la infección por el VIH y permite conocer el patrón de crecimiento de la epidemia y la tasa de transmisión de cepas resistentes a los antirretrovirales, que en España es del 10%; b) inmunopatológico, ya que es una oportunidad única para estudiar los mecanismos virológicos, inmunológicos, y genéticos implicados en la transmisión y patogenia de esta enfermedad; y c) terapéutico, ya que el inicio del tratamiento antirretroviral en esta fase podría modificar la historia natural de esta infección. Sin embargo, este es un tema controvertido y en la actualidad la mayoría de comités de expertos sólo recomiendan el tratamiento si se pueden incluir los pacientes en ensayos clínicos o si las manifestaciones clínicas son graves o duraderas.
Palabras clave:
Infección aguda
VIH
Tratamiento antirretroviral
According the WHO there are about 14,000 new HIV infections a day. However, in a few cases the diagnosis will be made in the acute phase of the disease. Acute HIV infection is the period between infection with the virus and complete seroconversion, defined by a positive Western blot test. This period lasts approximately 30 days and most patients (40-90%) have mild clinical manifestations (fever, rash, pharyngitis, mucosal ulcers, among others) for 2 weeks which, because they are nonspecific, can be confused with other community-acquired infections. Microbiological diagnosis is based on the absence of serum antibodies (negative ELISA test) together with a positive HIV viral load in plasma (> 10,000 copies/ml). Diagnosis of acute HIV infection is important for several reasons: firstly, from the epidemiological point of view, this is the period with the highest rates of HIV transmission and identification of new HIV infections reveals the growth of the epidemic and the transmission rates of resistant HIV strains, which in Spain is about 10%; secondly, from the immunopathological point of view, this period provides a unique opportunity to study the virological, immunological and genetic mechanisms that play a role in the transmission and pathogenesis of this disease; and thirdly, therapeutically, tarting antiretroviral therapy during this phase could alter the natural history of the disease. However, this is a controversial issue and currently most guidelines recommend treatment only if these patients can be included in clinical trials or if they show lasting or severe clinical manifestations.
Key words:
Acute infection
HIV
Antiretroviral treatment
El Texto completo está disponible en PDF
Bibliografía
[1.]
World Health Organization. AIDS epidemic uptade 2003. Disponible en; http://who.int/hiv/pub/epidemiology/imagefile/en/print.html [Consulta: 10 de Octubre de 2004]
[2.]
C.D. Wilcher, H.C. Tien, J.J. Eron Jr, P.L. Vernazza, S.Y. Leu, P.W. Stewart, et al.
Brief but Efficient: Acute HIV Infection and the Sexual Transmission of HIV.
J Infect Dis, 189 (2004), pp. 1785-1792
[3.]
S. Yerly, S. Vora, P. Rizzardi, J.P. Chave, P.L. Vernazza, M. Fleep, et al.
Acute HIV infection: impact on the spread of HIV and transmission of drug ressistance.
Aids, 15 (2001), pp. 2287-2292
[4.]
J.S. Koopman, J.A. Jacquez, G.W. Welch, C.P. Simon, B. Foxman, S.M. Pollock, et al.
The role of early HIV infection in the spread of HIV trough populations.
J Acquir Immune Defic Syndr Hum Retrovirol, 14 (1997), pp. 249-258
[5.]
J.A. Jacquez, J.S. Koopman, C.P. Simon, I.M. Longini Jr..
Role of the primary infectionin epidemics of HIV infection in gay cohorts.
J Acquir Immune Defic Syndr, 7 (1994), pp. 1169-1189
[6.]
G.W. Rutherford, S.K. Schwarcz, W. McFarland.
Surveillance for incident HIV infection: new technology and new opportunities.
J Acquir Immune Defic Syndr, 25 (2000), pp. S115-S119
[7.]
R.T. Gandhi, A. Wurcel, E.S. Rosenberg, M.N. Johnston, N. Hellmann, M. Bates, et al.
Progressive reversion of human immunodeficiency virus type 1 resistance mutations in vivo after transmission of a multiply drug-resistant virus.
Clin Infect Dis, 37 (2003), pp. 1693-1698
[8.]
G.R. Kaufmann, P. Cunningham, J. Zaunders, M. Law, J. Vizzard, A. Carr, et al.
Impact of early HIV-1 RNA and T-lymphocyte dynamics during primary HIV-1 infection on the subsequent course of HIV-1 RNA levels and CD4+ T-lymphocyte counts in the first year of HIV-1 infection. Sydney Primary HIV Infection Study Group.
J Acquir Immune Defic Syndr, 22 (1999), pp. 437-444
[9.]
L. Lavreys, J.M. Baeten, J. Overbaugh, D.D. Panteleeff, B.H. Chohan, B.A. Richardson, et al.
Virus load during primary human immunodeficiency virus (HIV) type 1 infection is related to the severity of acute HIV illness in Kenyan women.
Clin Infect Dis, 35 (2002), pp. 77-81
[10.]
F. Lori, H. Jessen, J. Lieberman, D. Finzi, E. Rosenberg, C. Tinelli, et al.
Treatment of human immunodeficiency virus infection with hydroxyurea, didanosine, and a protease inhibitor before seroconversion is associated with normalized immune parameters and limited viral reservoir.
J Infect Dis, 180 (1999), pp. 1827-1832
[11.]
M. Pope, A. Haase.
Transmision, acute HIV-1 infection and the quest for strategies to prevent infection.
Nature Med, 9 (2003), pp. 847-852
[12.]
S. Kassutto, E.S. Rosenberg.
Primary HIV Type 1 Infection.
Clin Infect Dis, 38 (2004), pp. 1452-1458
[13.]
C.D. Pilcher, J.J. Eron, S. Galvin, C. Gay, M.S. Cohen.
Acute HIV revisited: new opportunities for treatment and prevention.
J Clin Invest, 113 (2004), pp. 937-945
[14.]
B. Auvert, A. Buve, E. Lagarde, M. Kahindo, J. Chege, N. Rutenberg, et al.
Study Group on the Heterogeneity of HIV Epidemics in African Cities. Male circumcision and HIV infection in four cities in sub-Saharan Africa.
Aids, 15 (2001), pp. S31-S40
[15.]
S.E. Msuya, E. Mbizvo, B. Stray-Pedersen, J. Sundby, N.E. Sam, A. Hussain.
Reproductive tract infections and the risk of HIV among women in Moshi, Tanzania.
Acta Obstet Gynecol Scand, 81 (2002), pp. 886-893
[16.]
H.L. Martin, B.A. Richardson, P.M. Nyange, L. Lavreys, S.L. Hillier, B. Chohan, et al.
Vaginal lactobacilli, microbial flora, and risk of human immunodeficiency virus type 1 and sexually transmitted disease acquisition.
J Infect Dis, 180 (1999), pp. 1863-1868
[17.]
T. Dragic.
An overview of the determinants of CCR5 and CXCR4 co-receptor function.
J Gen Virol, 82 (2001), pp. 1807-1814
[18.]
J. Hu, M.B. Gardner, C.J. Miller.
Simian immunodeficiency virus rapidly penetrates the cervicovaginal mucosa after intravaginal inoculation and infects intraepithelial dendritic cells.
J Virol, 74 (2000), pp. 6087-6095
[19.]
Z. Zhang, T. Schuler, M. Zupancic, S. Wietgrefe, K.A. Staskus, K.A. Reimann, et al.
Sexual transmission and propagation of SIV and HIV in resting and activated CD4+ T cells.
Science, 286 (1999), pp. 1353-1357
[20.]
D.D. Ho, A.U. Neumann, A.S. Perelson, W. Chen, J.M. Leonard, M. Markowitz.
Rapid turnover of plasma virions and CD4 lymphocytes in HIV-1 infection.
Nature, 373 (1995), pp. 123-126
[21.]
R.L. Gascon, A.B. Narváez, R. Zhang, J.O. Kahn, F.M. Hecht, B.G. Herndier, et al.
Increased HLA-DR expression on peripheral blood monocytes in subsets of subjects with primary HIV infection is associated with elevated CD4 T-cell apoptosis and CD4 T-cell depletion.
J Acquir Immune Defic Syndr, 30 (2002), pp. 146-153
[22.]
M. Stevenson.
HIV-1 pathogenesis.
Nature Med, 9 (2003), pp. 853-860
[23.]
J.E. Schmitz, M.J. Kuroda, S. Santra, M.A. Simon, M.A. Lifton, W. Lin, et al.
Effect of humoral immune responses on controlling viremia during primary infection of rhesus monkeys with simian immunodeficiency virus.
J Virol, 77 (2003), pp. 2165-2173
[24.]
D. Vittecoq, S. Chevret, L. Morand-Joubert, F. Heshmati, F. Audat, M. Bary, et al.
Passive immunotherapy in AIDS: a double-blind randomized study based on transfusions of plasma rich in anti-human immunodeficiency virus 1 antibodies vs. transfusions of seronegative plasma.
Proc Natl Acad Sci USA, 92 (1995), pp. 1195-1199
[25.]
J.R. Mascola, G. Stiegler, T.C. VanCott, H. Katinger, C.B. Carpenter, C.E. Hanson, et al.
Protection of macaques against vaginal transmission of a pathogenic HIV-1/SIV chimeric virus by passive infusion of neutralizing antibodies.
Nat Med, 6 (2000), pp. 207-210
[26.]
Y. Nishimura, T. Igarashi, N.L. Haigwood, R. Sadjadpour, O.K. Donau, C. Buckler, et al.
Transfer of neutralizing IgG to macaques 6 h but not 24 h after SHIV infection confers sterilizing protection: implications for HIV-1 vaccine development.
Proc Natl Acad Sci USA, 100 (2003), pp. 15131-15136
[27.]
N. Letvin, B. Walker.
Immunopathogenesis and immunotherapy in AIDS virus infections.
Nature, 9 (2003), pp. 861-866
[28.]
F. Cocchi, A.L. DeVico, A. Garzino-Demo, S.K. Arya, R.C. Gallo, P. Lusso.
Identification of RANTES, MIP-1 alpha, and MIP-1 beta as the major HIV-suppressive factors produced by CD8+ T cells.
Science, 270 (1995), pp. 1811-1815
[29.]
F. Cocchi, A.L. DeVico, R. Yarchoan, R. Redfield, F. Cleghorn, W.A. Blattner, et al.
Higher macrophage inflammatory protein (MIP)-1alpha and MIP-1beta levels from CD8+ T cells are associated with asymptomatic HIV-1 infection.
Proc Natl Acad Sci USA, 97 (2000), pp. 13812-13817
[30.]
L. Zhang, W. Yu, T. He, J. Yu, R.E. Caffrey, E.A. Dalmasso, et al.
Contribution of human alpha-defensin 1, 2, and 3 to the anti-HIV-1 activity of CD8 antiviral factor.
Science, 298 (2002), pp. 995-1000
[31.]
J.E. Schmitz, M.J. Kuroda, S. Santra, V.G. Sasseville, M.A. Simon, M.A. Lifton, et al.
Control of viremia in simian immunodeficiency virus infection by CD8+ lymphocytes.
Science, 283 (1999), pp. 857-860
[32.]
D.H. Barouch, S. Santra, J.E. Schmitz, M.J. Kuroda, T.M. Fu, W. Wagner, et al.
Control of viremia and prevention of clinical AIDS in rhesus monkeys by cytokine-augmented DNA vaccination.
Science, 290 (2000), pp. 486-492
[33.]
G.M. Ortiz, D.F. Nixon, A. Trkola, J. Binley, X. Jin, S. Bonhoeffer, et al.
HIV-1 specific immune responses in subjets who temporarily contain virus replication after discontinuation of higly antiretroviral therapy.
J Clin Invest, 104 (1999), pp. R13-18
[34.]
C. Liu, M. Carrington, R.A. Kaslow, X. Gao, C.R. Rinaldo, L.P. Jacobson, et al.
Association of polymorphisms in human leukocyte antigen class I and transporter associated with antigen processing genes with resistance to human immunodeficiency virus type 1 infection.
J Infect Dis, 187 (2003), pp. 1404-1410
[35.]
X. Gao, G.W. Nelson, P. Karacki, M.P. Martin, J. Phair, R. Kaslow, et al.
Effect of a single amino acid change in MHC class I molecules on the rate of progression to AIDS.
N Engl J Med, 344 (2001), pp. 1668-1675
[36.]
S.A. Migueles, M.S. Sabbaghian, W.L. Shupert, M.P. Bettinotti, F.M. Marincola, L. Martino, et al.
HLA B*5701 is highly associated with restriction of virus replication in a subgroup of HIV-infected long term nonprogressors.
Proc Natl Acad Sci USA, 97 (2000), pp. 2709-2714
[37.]
P.J. Goulder, C. Brander, Y. Tang, C. Tremblay, R.A. Colbert, M.M. Addo, et al.
Evolution and transmission of stable CTL escape mutations in HIV infection.
Nature, 412 (2001), pp. 334-338
[38.]
P.W. Parren, J.P. Moore, D.R. Burton, Q.J. Sattentau.
The neutralizing antibody response to HIV-1: viral evasion and escape from humoral immunity.
Aids, 13 (1999), pp. S137-S162
[39.]
J.K. Wong, M. Hezareh, H.F. Gunthard, D.V. Havlir, C.C. Ignacio, C.A. Spina, et al.
Recovery of replication-competent HIV despite prolonged suppression of plasma viremia.
Science, 278 (1997), pp. 1291-1295
[40.]
R.J. Pomerantz.
Reservoirs of human immunodeficiency virus type 1: the main obstacles to viral eradication.
Clin Infect Dis, 34 (2002), pp. 91-97
[41.]
D.A. Cooper, J. Gold, P. Maclean, B. Donovan, R. Finlayson, T.G. Barnes, et al.
Acute AIDS retrovirus infection. Definition of a clinical illness associated with seroconversion.
Lancet, 1 (1985), pp. 537-540
[42.]
T. Schacker, A.C. Collier, J. Hughes, T. Shea, L. Corey.
Clinical and epidemiologic features of primary HIV infection.
Ann Intern Med, 125 (1996), pp. 257-264
[43.]
R.C. Bollinger, R.S. Brookmeyer, S.M. Mehendale, R.S. Paranjape, M.E. Shepherd, D.A. Gadkari, et al.
Risk factors and clinical presentation of acute primary HIV infection in India.
Jama, 278 (1997), pp. 2085-2089
[44.]
B. Tindall, D.A. Cooper, B. Donovan, R. Penny.
Primary human immunodeficiency virus infection. Clinical and serologic aspects.
Infect Dis Clin North Am, 2 (1988), pp. 329-341
[45.]
P. Vanhems, C. Dassa, J. Lambert, D.A. Cooper, L. Perrin, J. Vizzard, et al.
Comprehensive classification of symptoms and signs reported among 218 patients with acute HIV-1 infection.
J Acquir Immune Defic Syndr, 21 (1999), pp. 99-106
[46.]
A. Lafeuillade, P. Chaffanjon, P. Pellegrino, D. Andreotti, J.F. Filippi, B. Barrere, et al.
Oesophageal candidiasis in primary HIV infection.
Eur J Med, 1 (1992), pp. 126
[47.]
J.M. Pena, M.A. Martínez-López, F. Arnalich, F.J. Barbado, J.J. Vázquez.
Esophageal candidiasis associated with acute infection due to human immunodeficiency virus: case report and review.
Rev Infect Dis, 13 (1991), pp. 872-875
[48.]
F. Mateos Rodríguez, A. Fuertes Martín, M. Marcos Toledano, A. Jiménez López.
Primary HIV infection with esophageal candidiasis and acute toxoplasmosis.
An Med Interna, 1 (1998), pp. 50-51
[49.]
S. Szabo, C.W. James, G. Telford.
Unusual presentations of primary human immunodeficiency virus infection.
AIDS Patient Care STDS, 16 (2002), pp. 251-254
[50.]
P.J. Moss, R.C. Read, G. Kudesia, M.W. McKendrick.
Prolonged cryptosporidiosis during primary HIV infection.
J Infect, 30 (1995), pp. 51-53
[51.]
S. Vento, G. Di Perri, T. Garofano, E. Concia, D. Bassetti.
Pneumocystis carinii pneumonia during primary HIV-1 infection.
Lancet, 342 (1993), pp. 24-25
[52.]
F.M. Hecht, M.P. Busch, B. Rawal, M. Webb, E. Rosenberg, M. Swanson, et al.
Use of laboratory tests and clinical symptoms for identification of primary HIV infection.
Aids, 16 (2002), pp. 1119-1129
[53.]
L. Lavreys, M.L. Thompson, H.L. Martin Jr, K. Mandaliya, J.O. Ndinya-Achola, J.J. Bwayo, et al.
Primary human immunodeficiency virus type 1 infection: clinical manifestations among women in Mombasa, Kenya.
Clin Infect Dis, 30 (2000), pp. 486-490
[54.]
P. Vanhems, N. Voirin, B. Hirschel, D.A. Cooper, J. Vizzard, A. Carr, et al.
Brief report: incubation and duration of specific symptoms at acute retroviral syndrome as independent predictors of progression to AIDS.
J Acquir Immune Defic Syndr, 32 (2003), pp. 542-544
[55.]
P. Vanhems, B. Hirschel, A.N. Phillips, D.A. Cooper, J. Vizzard, J. Brassard, et al.
Incubation time of acute human immunodeficiency virus (HIV) infection and duration of acute HIV infection are independent prognostic factors of progression to AIDS.
J Infect Dis, 182 (2000), pp. 334-337
[56.]
W.A. Blattner, K. Ann Oursler, F. Cleghorn, M. Charurat, A. Sill, C. Bartholomew, et al.
Rapid clearance of virus after acute HIV-1 infection: correlates of risk of AIDS.
J Infect Dis, 189 (2004), pp. 1793-1801
[57.]
M. Altfeld, M.M. Addo, E.S. Rosenberg, F.M. Hecht, P.K. Lee, M. Vogel, et al.
Influence of HLA-B57 on clinical presentation and viral control during acute HIV-1 infection.
Aids, 17 (2003), pp. 2581-2591
[58.]
S. Kinloch-de Loes, P. De Saussure, J.H. Saurat, H. Stalder, B. Hirschel, L.H. Perrin.
Symptomatic primary infection due to human immunodeficiency virus type 1: review of 31 cases.
Clin Infect Dis, 17 (1993), pp. 59-65
[59.]
J. Lima, A. Ribera, F. García-Bragado, M. Monteagudo, C. Martín-Vega, M.T. Bastida.
Antiplatelet antibodies in primary infection by human immunodeficiency virus.
Ann Intern Med, 106 (1987), pp. 333
[60.]
M. Flemmer, E.C. Oldfield 3rd, B.H. Melek.
Acute retroviral disease masquerading as bacterial sepsis: the “bands” play on.
South Med J, 89 (1996), pp. 354-355
[61.]
S.L. Pett, G.J. Dore, R.J. Fielden, D.A. Cooper.
Cyclical hepatitis and early liver cirrhosis after hepatitis C seroconversion during pulsed antiretroviral therapy for primary HIV-1.
Aids, 16 (2002), pp. 2364-2365
[62.]
S. Verma, E. Micsa, L. Estanislao, D. Simpson.
Neuromuscular complications in HIV.
Curr Neurol Neurosci Rep, 4 (2004), pp. 62-67
[63.]
J. Zaunders, A. Carr, L. McNally, R. Penny, DA. Cooper.
Effects of primary HIV-1 infection on subsets of CD4+ and CD8+ T lymphocytes.
Aids, 9 (1995), pp. 561-566
[64.]
R.L. Gascon, A.B. Narváez, R. Zhang, J.O. Kahn, F.M. Hecht, B.G. Herndier, et al.
Increased HLA-DR expression on peripheral blood monocytes in subsets of subjects with primary HIV infection is associated with elevated CD4 T-cell apoptosis and CD4 T-cell depletion.
J Acquir Immune Defic Syndr, 30 (2002), pp. 146-153
[65.]
A. Biglino, A. Sinicco, B. Forno, A.M. Pollono, M. Sciandra, C. Martini, et al.
Serum cytokine profiles in acute primary HIV-1 infection and in infectious mononucleosis.
Clin Immunol Immunopathol, 78 (1996), pp. 61-69
[66.]
P. Vanhems, R. Allard, D.A. Cooper, L. Perrin, J. Vizzard, B. Hirschel, et al.
Acute human immunodeficiency virus type 1 disease as a mononucleosislike illness: is the diagnosis too restrictive?.
Clin Infect Dis, 24 (1997), pp. 965-970
[67.]
R.P. Walensky, E.S. Rosenberg, M.J. Ferraro, E. Losina, B.D. Walker, K.A. Freedberg.
Investigation of primary human immunodeficiency virus infection in patients who test positive for heterophile antibody.
Clin Infect Dis, 33 (2001), pp. 570-572
[68.]
E.S. Daar, S. Little, J. Pitt, J. Santangelo, P. Ho, N. Harawa, et al.
Diagnosis of primary HIV-1 infection.
Ann Intern Med, 134 (2001), pp. 25-29
[69.]
H.A. Kessler, B. Blaauw, J. Spear, D.A. Paul, L.A. Falk, A. Landay.
Diagnosis of human immunodeficiency virus infection in seronegative homosexuals presenting with an acute viral syndrome.
Jama, 258 (1987), pp. 1196-1199
[70.]
R. Thorstensson, S. Andersson, S. Lindback, F. Dias, F. Mhalu, H. Gaines, et al.
Evaluation of 14 commercial HIV-1/HIV-2 antibody assays using serum panels of different geographical origin and clinical stage including a unique seroconversion panel.
J Virol Methods, 70 (1998), pp. 139-151
[71.]
B. Weber, T. Meier, G. Enders.
Fourth generation human immunodeficiency virus (HIV) screening assays with an improved sensitivity for p24 antigen close the second diagnostic window in primary HIV infection.
J Clin Virol, 25 (2002), pp. 357-359
[72.]
M.L. Delforge, N. Dolle, P. Hermans, C. Liesnard.
Delayed HIV primary infection diagnosis with a fourth-generation HIV assay.
Aids, 16 (2002), pp. 128-130
[73.]
B.K. Mukadi, B. Vandercam, M. Bodeus, M. Moreau, P. Goubau.
An HIV seroconversion case:unequal performance of combined antigen/antibodies assays.
Aids, 16 (2002), pp. 127-128
[74.]
S. Lindback, R. Thorstensson, A.C. Karlsson, M. Von Sydow, L. Flamholc, A. Blaxhult, et al.
Diagnosis of primary HIV-1 infection and duration of follow-up after HIV exposure.
Aids, 14 (2000), pp. 2333-2339
[75.]
S.B. Gupta, O.N. Gill, C. Graham, A.D. Grant, P.A. Rogers, G. Murphy.
What a test for recent infection might reveal about HIV incidence in England and Wales.
Aids, 14 (2000), pp. 2597-2601
[76.]
M.H. Merson.
Early detection: the next steps.
J Acquir Immune Defic Syndr, 25 (2000), pp. S157-S159
[77.]
R.S. Janssen, G.A. Satten, S.L. Stramer, B.D. Rawal, T.R. O’Brien, B.J. Weiblen, et al.
New testing strategy to detect early HIV-1 infection for use in incidence estimates and for clinical and prevention purposes.
Jama, 280 (1998), pp. 42-48
[78.]
N.T. Constantine, A.M. Sill, N. Jack, K. Kreisel, J. Edwards, T. Cafarella, et al.
Improved classification of recent HIV-1 infection by employing a two-stage sensitive/less-sensitive test strategy.
J Acquir Immune Defic Syndr, 32 (2003), pp. 94-103
[79.]
E.W. Fiebig, D.J. Wright, B.D. Rawal, P.E. Garrett, R.T. Schumacher, L. Peddada, et al.
Dynamics of HIV viremia and antibody seroconversion in plasma donors: implications for diagnosis and staging of primary HIV infection.
Aids, 17 (2003), pp. 1871-1879
[80.]
R.W. Shafer.
Genotypic testing for human immunodeficiency virus type 1 drug resistance.
Clin Microbiol Rev, 15 (2002), pp. 247-277
[81.]
S.J. Little, S. Holte, J.P. Routy, E.S. Daar, M. Markowitz, A. Collier, et al.
Antiretroviral drug resistance among patients recently infected with HIV.
N Engl J Med, 347 (2002), pp. 385-394
[82.]
R.M. Grant, F.M. Hecht, M. Warmerdam, L. Liu, T. Liegler, C.J. Petropoulus, et al.
Time trends in primary HIV-1 drug resistant among recently infected persons.
Jama, 288 (2002), pp. 181-188
[83.]
V. Simon, C. Hogan, M. Louie, S. Vasan, L. Rowe, N. Padte, et al.
Frequency of transmitted drug resistance and identification of phylogenetic clusters in a homogenous cohort of newly infected individuals. Abstract 504.
10th Conference on retrovirus and opportunistic infections, (2003),
[84.]
M.L. Chaix, D. Descamps, C. Deveau, V. Scheneider, M. Harzic, C. Tamalet, et al.
Antiretroviral resistance, molecular epidemiology and response to initial therapy among patients with HIV-1primary infection in France (1999-2000). Abstract 166. XI International HIV Drug Resistance Whorshop.
Antiviral Therapy, 7 (2002), pp. S138
[85.]
C. Briones, M. Pérez Olmeda, C. Rodríguez, J. Del Romero, K. Hertogs, V. Soriano.
Primary genotypic and phenotypic HIV-1 drug resistant in recent seroconverters in Madrid.
J Acquir Immun Defic Syndr, 26 (2001), pp. 145-150
[86.]
C. De Mendoza, J. Del Romero, C. Rodríguez, A. Corral, V. Soriano.
Decline in the rate of phenotypic resistant to ARV drugs in recent HIV seroconverters in Madrid.
Aids, 16 (2002), pp. 1830-1832
[87.]
A.M. Wensing, D.A. Van de Vijvier, B. Asjo, ?.?. Balotta, R. Camacho, A. De Luca, et al.
Analisys from more than 1600 new diagnosed patient with HIV from 17 European Countries show that 10% of the patients carry primary drug resistance: The CATCH study. Oral Late Breakers. 2.a.
[88.]
M. Violín, F. Forbici, A. Cotzzi-Lepri, R. Velleca, A. Bertoli, C. Riba, et al.
Primary HIV-1 resistance in recently and chronicaly infected individuals of the Italian Cohort naive for Antriretrovirals.
J Biol Regul Homeos Agents, 16 (2002), pp. 37-43
[89.]
S.J. Little, S. Holte, J.P. Routy, E.S. Daar, M. Markowitz, A.C. Coller, et al.
Antiretroviral drugs resitance among patients recently infected with HIV.
N Engl J Med, 347 (2002), pp. 385-394
[90.]
UK Collaborative Group on Monitoring the transmission of HIV Drug Resistance. Analysis of prevalence of HIV-1 drug resistance in primary infection in the United Kingdom..
Bmj, 322 (2001), pp. 1087-1088
[91.]
J.M. Gatell, J.L. Blanco, J. Alcamí, A. Antela, J. Arrizabalaga, J.L. Casado, et al.
Documento de consenso de GESIDA sobre la utilización de los estudios de resistencias en la práctica clínica.
Enferm Infec Microbiol Clin, 19 (2001), pp. 53-60
[92.]
M.S. Hirsch, F. Brun-Vezinet, B. Clotet, B. Conway, D.R. Kuritzkes, R.T. D’Aquila, et al.
Antiretroviral drug resistance testing in adults infected with human immunodeficiency virus type 1: 2003 recommendations of an International AIDS Society-USA Panel.
Clin Infect Dis, 37 (2003), pp. 113-128
[93.]
K.C. Chan, R.A. Galli, J.S. Montaner, P.R. Harrigan.
Prolonged retention of drug resistance mutations and rapid disease progression in the absence of therapy after primary HIV infection.
Aids, 17 (2003), pp. 1256-1258
[94.]
J.D. Barbour, F.M. Hecht, T. Wrin, T.J. Liegler, C.A. Ramstead, M.P. Busch, et al.
Persistence of primary drug resistance among recently HIV-1 infected adults.
Aids, 18 (2004), pp. 1683-1689
[95.]
J.D. Barbour, F.M. Hecht, T. Wrin, M.R. Segal, C.A. Ramstead, T.J. Liegler, et al.
Higher CD4+ T cell counts associated with low viral pol replication capacity among treatment-naive adults in early HIV-1 infection.
J Infect Dis, 190 (2004), pp. 251-256
[96.]
M. Markowitz, M. Vesanen, K. Tenner-Racz, J. Cao, J.M. Binley, R. Chaundry, et al.
The effect of commencing antiretroviral therapy soon after human immunodeficiency virus type 1 infection on viral replication and antiviral immune responses.
J Infect Dis, 179 (1999), pp. 527-537
[97.]
V. Schiffer, C. Deveau, L. Meyer, I. Iraqui, A. Nguyen-Wartel, M.L. Chaix, et al.
Recent changes in the management of primary HIV-1 infection: results from the French PRIMO cohort.
HIV Med, 5 (2004), pp. 326-333
[98.]
D.E. Cohen, B.D. Walker.
Human immunodeficiency virus pathogenesis and prospects for immune control in patients with established infection.
Clin Infect Dis, 32 (2001), pp. 1756-1768
[99.]
A. Oxenius, S. Fidler, M. Brady, S.J. Dawson, K. Ruth, P.J. Easterbrook, et al.
Variable fate of virus-specific CD4(+) T cells during primary HIV-1 infection.
Eur J Immunol, 31 (2001), pp. 3782-3788
[100.]
A. Oxenius, S. Yerly, E. Ramírez, R.E. Phillips, D.A. Price, L. Perrin.
Distribution of functional HIV-specific CD8 T lymphocytes between blood and secondary lymphoid organs after 8-18 months of antiretroviral therapy in acutely infected patients.
Aids, 15 (2001), pp. 1653-1656
[101.]
M. Altfeld, E.S. Rosenberg, R. Shankarappa, J.S. Mukherjee, F.M. Hecht, R.L. Eldridge, et al.
Cellular immune responses and viral diversity in individuals treated during acute and early HIV-1 infection.
J Exp Med, 193 (2001), pp. 169-180
[102.]
D.E. Smith, B.D. Walker, D.A. Cooper, E.S. Rosenberg, J.M. Kaldor.
Is antiretroviral treatment of primary HIV infection clinically justified on the basis of current evidence?.
Aids, 18 (2004), pp. 709-718
[103.]
N. Voirin, D. Smith, J.P. Routy, M. Legault, D. Baratin, C. Trepo, et al.
Effect of Treatment during versus after acute retroviral syndrome (ARS) on HIV Viral Load and CD4 Cell Counts within 3 Years of Infection.
[104.]
S. Kinloch-De Loes, B.J. Hirschel, B. Hoen, D.A. Cooper, B. Tindall, A. Carr, et al.
Controlled trial of zidovudine in pri mary human immunodeficiency virus infection.
N Engl J Med, 333 (1995), pp. 408-413
[105.]
M.T. Niu, J. Bethel, M. Holodniy, H.C. Standiford, S.M. Schnittman.
Zidovudine treatment in patients with primary (acute) human immunodeficiency virus type 1 infection: a randomized, double-blind, placebo-controlled trial. DATRI 002 Study Group. Division of AIDS Treatment Research Initiative.
J Infect Dis, 178 (1998), pp. 80-91
[106.]
S. Kinloch-de Loes, T.V. Perneger.
Primary HIV infection: follow-up of patients initially randomized to zidovudine or placebo.
J Infect, 35 (1997), pp. 111-116
[107.]
D. Smith, M.M. Berrey, M. Robertson, D. Mehrotra, M. Markowitz, L. Perrin, et al.
Virological and immunological effects of comibnation antiretroviral therapy with zidovudine, lamivudine and indinavir during primary HIV-1 infection.
J Infect Dis, 182 (2000), pp. 950-954
[108.]
B. Hoen, B. Dumon, M. Harzic, A. Venet, B. Dubeaux, C. Lascoux, et al.
HAART initiated early in the course of the symptomatic primary HIV-1 infection: results of the ANRS 053 trial.
J Infect Dis, 180 (1999), pp. 1342-1346
[109.]
S. Portsmouth, N. Imami, A. Pires, J. Stebbing, J. Hand, M. Nelson, et al.
Treatment of primary HIV-1 infection with nonnucleoside reverse transcriptase inhibitor-based therapy is effective and well tolerated.
HIV Med, 5 (2004), pp. 26-29
[110.]
M.M. Berrey, T. Shacker, A.C. Collier, T. Shea, S.J. Brodie, D. Mayers, et al.
Treatment of Primary Immunodeficiecy Virus type 1Infection with Potent Antiretroviral Therapies Reduces Frequency of Rapid Progresion to AIDS.
J Infect Dis, 183 (2001), pp. 1466-1475
[111.]
J. Miller, A. Carr, D. Smith, S. Emery, M.G. Law, P. Grey, et al.
Lipodystrophy following antiretroviral therapy of primary HIV infection.
Aids, 14 (2000), pp. 2406-2407
[112.]
C. Goujard, F. Boufassa, C. Deveau, D. Laskri, L. Meyer.
Incidence of clinical lipodystrophy in HIV-infected patients treated during primary infection.
Aids, 15 (2001), pp. 282-284
[113.]
P. Narciso, V. Tozzi, G. D’Offizi, G. De Carli, N. Orchi, V. Galati, et al.
Metabolic and morphologic disorders in patients treated with highly active antiretroviral therapy since primary HIV infection.
Ann N Y Acad Sci, 946 (2001), pp. 214-222
[114.]
P.M. Girard, V. Schneider, A. Dehee, P. Mariot, C. Jacomet, N. Delphin, et al.
Treatment interruption after one year of triple nucleoside analogue therapy for primary HIV infection.
Aids, 15 (2001), pp. 275-277
[115.]
M. Markowitz, X. Jin, A. Hurlex, V. Simon, B. Ramratnam, M. Louie, et al.
Discontinuation of antiretroviral therapy commenced early during the course of HIV-1 infection, with or without adjuntive vaccination.
J Infec Dis, 186 (2002), pp. 634-643
[116.]
R.H. Lyles, A. Munoz, T.E. Yamashita, H. Bazmi, R. Detels, C.R. Rinaldo, et al.
Natural history of human immunodeficiency virus type 1 viremia after seroconversion and proximal to AIDS in a large cohort of homosexual men. Multicenter AIDS Cohort Study.
J Infect Dis, 181 (2000), pp. 872-880
[117.]
S. Fidler, A. Oxenius, M. Brady, J. Clarke, I. Cropley, A. Babiker, et al.
Virological and immunological effects of short course antiretroviral therapy in primary HIV infection.
Aids, 16 (2002), pp. 2049-2054
[118.]
Anónimo. Survival after introduction of HAART in people with known duration of HIV-1 infection. The CASCADE Collaboration. Concerted Action on SeroConversion to AIDS and Death in Europe..
Lancet, 355 (2000), pp. 1158-1159
[119.]
J. Lisziewicz, E. Rosenberg, J. Lieberman, H. Jessen, L. Lopalco, R. Siliciano, et al.
Control of HIV despite the discontinuation of antiretroviral therapy.
N Engl J Med, 340 (1999), pp. 1683-1684
[120.]
E.S. Rosenberg, M. Altfeld, S.H. Poon, M.N. Phillips, B.M. Wikes, R.L. Elridge, et al.
Immune control of HIV-1 after early treatment of acute infection.
Nature, 407 (2000), pp. 523-526
[121.]
F. Lori, M.G. Lewis, J. Xu, G. Varga, D.E. Zinn Jr, C. Crabbs, et al.
Control of SIV rebound through structured treatment interruptions during early infection.
Science, 290 (2000), pp. 1591-1593
[122.]
D. Kaufmann, M. Lichterfeld, M. Altfeld, T. Allen, M. Johnston, P. Lee, et al.
Limited durability of immune control following treated acute HIV infection.
[123.]
B. Hoen, I. Fournier, I. Charreau, C. Lacabaratz, M. Burgard, C. Arvieux, et al.
Final Results of the Multicenter Prospective PRIMSTOP Pilot Trial.
[124.]
J.M. Miró, M. Plana, F. García, G.M. Ortiz, M.J. Maleno, M. Arnedo, et al.
Structured treatment interruptions (STI) in patients receiving HAART within 90 days after onset of primary HIV-1 infection (PHI) symptoms: spontaneous control of viremia in only one third of cases after four cycles off therapy.
[125.]
J.M. Miró, M. Plana, F. García, G.M. Ortiz, M.J. Maleno, O. Sued, et al.
Low-dose daily IL-2 combined with structured treatment interruptions (STI) did not increase the HIV-1-specific T-cell responses in patients receiving HAART with 90 days after onset primary HIV-1 infection (PHI) symptoms.
[126.]
C.L. Tremblay, J.L. Hicks, L. Sutton, F. Giguel, T. Flynn, M. Johnston, et al.
Antiretroviral resistance associated with supervised treatment interruptions in treated acute HIV infection.
Aids, 17 (2003), pp. 1086-1089
[127.]
E. Ravot, G. Tambussi, H. Jessen, C. Tinelli, A. Lazzarin, J. Lisziexicz, et al.
Effects of hidroxiurea on T cell count changes during primary HIV infection.
Aids, 14 (2000), pp. 619-622
[128.]
C. Zala, H. Salomon, C. Ochoa, G. Kijak, A. Federico, H. Perez, et al.
Higher rate of toxiocity with no increased efficacy when hydroxyurea is added to a regimetn of stavudine plus didanosine and nevirapine in primary HIV infection.
J Acquir Immune Defic Syndr, 29 (2002), pp. 368-373
[129.]
G.P. Rizzardi, A. Harari, B. Capiluppi, G. Tambussi, K. Ellfsen, D. Ciuffreda, et al.
Treatment of primary HIV-1 infection with ciclosporin A coupled with HAART.
J Clin Invest, 109 (2002), pp. 681-688
[130.]
D. Emilie, M. Burgard, C. Lascoux Combre, M. Lauglin, R. Krzyiek, C. Pignosn, et al.
Early control of HIV replication in primary HIV-Infection treated with antiretroviral drugs and pegylated IFN alpha: results from the Primoferon A (ANRS 086) Study.
Aids, 15 (2001), pp. 1435-1437
[131.]
M. Dybul, B. Hidalgo, T.W. Chun, M. Belson, S.A. Migueles, J.S. Justement, et al.
Pilot study of the effects of intermittent interluekin-2 on human immunodeficiency virus specific responses in patients treated during recently acquired HIV infection.
J Infect Dis, 185 (2002), pp. 61-68
[132.]
A. Lufeillade, C. Poggi, S. Chadapaud, G. Hittinger, H. Khiri, P. Halfon, et al.
Impact of immune interventions on proviral HIV-1 DNA decay in patients receiving HAART.
HIV Med, 2 (2001), pp. 189-194
[133.]
J. Kulkosky, G. Nunnari, M. Otero, S. Calarota, G. Dornadula, H. Zhang, et al.
Intensification and stimulation therapy for human immunodeficiency virus type 1 reservoirs in infected persons receiving virally suppressive highly active antiretroviral therapy.
Infect Dis, 15;186 (2002), pp. 1403-1411
[134.]
J.W. Shiver, T.M. Fu, L. Chen, D.R. Casimiro, M.E. Davies, R.K. Evans, et al.
Replication-incompetent adenoviral vaccine vector elicits effective anti-immunodeficiency-virus immunity.
Nature, 415 (2002), pp. 331-335
[135.]
W. Lu, X. Wu, Y. Lu, W. Guo, J.M. Andrieu.
Therapeutic dendritic-cell vaccine for simian AIDS.
Nat Med, 9 (2003), pp. 27-32
[136.]
S. Kinloch, L. Perrin, B. Hoen, F. Lampe, A. Phillips, L. Goh, et al.
Evaluation of 2 therapeutic HIV vaccination regimens in HAART-treated primary HIV infection subjects following analytical treatment interruption: QUEST PROB3005, a randomized, placebo-controlled study.
[137.]
D. Cooper, C. Workman, R. Puls, M. Bloch, D. Baker, N. Bodsworth, et al.
Randomized, placebo-controlled, phase 1/2. A evaluation of the safety, biological activity and antiretroviral properties of an avipox virus vaccine expressing HIV gag-pol and interferon-gamma in HIV-1 infected subjects.
[138.]
S. Jost, M.C. Bernard, L. Kaiser, S. Yerly, B. Hirschel, A. Samri, et al.
A patient with HIV-1 superinfection.
N Engl J Med, 347 (2002), pp. 731-736
[139.]
G.S. Gottlied, D.C. Nickle, M.A. Jensen, K.G. Wong, J. Grobler, F. Li, et al.
Dual HIV-1 infection associated with rapid disease progression.
Lancet, 363 (2004), pp. 619-622
[140.]
Department of Health and Human Services (DHHS) and the Henry J. Kaiser Family Foundation. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Disponible en; http://www.hivatis.org. Revised March 23, 2004
[141.]
EACS Euroguidelines Group. European guidelines for the clinical management and treatment of HIV infected adults in Europe..
Aids, 17 (2003), pp. S3-S6
[142.]
A. Pozniak, B. Gazzard, J. Anderson, A. Babiker, D. Churchill, S. Collins, et al.
British HIV Association. Guidelines for the treatment of HIV diseases with ARV therapy 2003. British HIV Association (BHIVA) guidelines for the treatment of HIV-infected adults with antiretroviral therapy.
HIV Med, 4 (2003), pp. 1-41
[143.]
J.A. Iribarren, P. Labarga, R. Rubio, J. Berenguer, J.M. Miró, A. Antela, et al.
Recomendaciones de GESIDA/Plan Nacional sobre el Sida respecto al tratamiento antirretroviral en pacientes adultos infectados por el virus de la inmunodeficiencia humana (octubre 2004.
Enferm Infecc Microbiol Clin, (2004),
[144.]
J.A. Aberg, J.E. Gallant, J. Anderson, J.M. Oleske, H. Libman, J.S. Currier, et al.
Primary care guidelines for the management of persons infected with human immunodeficiency virus: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America.
Clin Infect Dis, 39 (2004), pp. 609-629
Copyright © 2004. Elsevier España, S.L.. Todos los derechos reservados
