More targeted interventions to diagnose HIV during acute infection are needed, researchers warn

Men who have sex with men (MSM) diagnosed with HIV in the acute phase of HIV infection have a greater number of recent sexual partners and more condomless sex than MSM diagnosed with chronic HIV infection, according to research published in the online edition of the Journal of Infectious Diseases. The study was conducted in Los Angeles. Men with acute HIV infection reported twice as many recent sexual partners and were also more likely to report condomless receptive and insertive anal sex than men with longer-standing infection.

“Our data demonstrate the increased behavioral risk among MSM with acute infection,” comment the researchers.

Viral load, and therefore potential infectiousness, is especially high in the acute phase of HIV infection.


acute infection

The very first few weeks of infection, until the body has created antibodies against the infection. During acute HIV infection, HIV is highly infectious because the virus is multiplying at a very rapid rate. The symptoms of acute HIV infection can include fever, rash, chills, headache, fatigue, nausea, diarrhoea, sore throat, night sweats, appetite loss, mouth ulcers, swollen lymph nodes, muscle and joint aches – all of them symptoms of an acute inflammation (immune reaction).


Having sex without condoms, which used to be called ‘unprotected’ or ‘unsafe’ sex. However, it is now recognised that PrEP and U=U are effective HIV prevention tools, without condoms being required. Nonethless, PrEP and U=U do not protect against other STIs. 


Insertive anal intercourse refers to the act of penetration during anal intercourse. The insertive partner is the ‘top’. 


Receptive anal intercourse refers to the act of being penetrated during anal intercourse. The receptive partner is the ‘bottom’.

nucleic acid amplification testing (NAAT)

A technology that allows detection of very small amounts of genetic material (DNA or RNA) in blood, plasma, and tissue. The viral load (HIV RNA) test is a type of nucleic acid amplification test (NAAT).

But an article published in an earlier edition of the journal concluded that because acute and early stages of HIV infection are of short duration (three and seven weeks, respectively), they do not require special interventions to control the HIV epidemic in most settings.

Researchers in Los Angeles were unconvinced by this assertion. They therefore designed a study analysing the sexual risk behaviour of MSM newly diagnosed with HIV between 2011 and 2015 at the LA LGBT Center.

A total of 912 MSM were newly diagnosed with HIV during the study period. Of these, 145 (16%) had acute infection (defined as a positive HIV nucleic acid amplification test – NAAT – but a negative HIV antibody text). The other 767 MSM had non-acute infection.

The newly diagnosed men provided information on their sexual activity in the three months before their diagnosis, including total number of sexual partners and anal sex without a condom.

MSM with acute infection had double the number of sexual partners in the previous 30 days (mean, 4.2; median 2) and three months (mean, 9.9; median 4) before their diagnosis compared to men with non-acute infection (30 day = mean, 2.4,  median, 4; three months = mean, 5.3, median, 2; p < 0.001).

Moreover, in the three months before diagnosis, unprotected receptive anal sex was more common among men with acute infection (65%) than men with non-acute infection (56%, p < 0.05). Men with acute infection were also more likely to report insertive anal sex without a condom in this three-month period (55 vs 50%).

“In our cohort, we demonstrate that MSM with acute HIV infection have nearly 2-times as many sex partners in the past 30-days and 3-months, when viremia is at its highest. Furthermore, those men were more likely to have condomless receptive and insertive anal intercourse,” conclude the investigators. “We argue that there is an urgent need to provide targeted interventions to MSM to diagnose acute infections, even at a greater cost, in order to reach them early with interventions and treatment to curb onward HIV transmission.”


Davey J et al. Sexual behavior during acute HIV infection among men who have sex with men in Los Angeles, California. J Infect Dis. Online edition, 2016

Suthar AB et al. Programmatic implications of acute and early HIV infection. J Infect Dis, 212: 1351-60, 2015.