Author(s) : F. Biron, D. Bonhour, Y. Ataman-Onal, B. Verrier, Service des maladies infectieuses
et tropicales,
Hôpital de la Croix-Rousse,
103, Grande-Rue de la Croix-Rousse, 69317 Lyon Cedex 04
francois.biron@chu-lyon.fr.
Summary : In the days following contamination by the Human Immunodeficiency Virus (HIV), the virus diffuses in the lymphoid organs and throughout the rest of the body, this is called Primary HIV Infection (PHI). The infection triggers an immune response that controls the replication and the diffusion of the virus. PHI is a critical period because the viral replication and diffusion is at its greatest, as in the terminal phase of the illness, and thus the risk of transmission is very high. Patients can be asymptomatic and ignore their illness, which in association with the high risk of contamination explains the preponderant role of PHI in the spread of the epidemic. Analysis of immunological, virological, and biological events allows the early identification of patients having an unfavorable prognosis. This implies that the detection of all PHI would limit the spread of the epidemic and allow for the treating of patients as early as possible. In most cases, PHI results in clinical manifestations, known as symptomatic (SPHI), which provide the opportunity to detect recent contamination. Diagnosis of SPHI necessitates a thorough understanding of the symptomatology which is unfortunately very polymorphic; it is difficult to describe a typical case scenario. Differential diagnoses are very numerous, but the appropriate usage of diagnostic tests and markers of viral replication allows for the identification of recent HIV infections. The level of viral replication in the months succeeding the SPHI is indicative of the subsequent evolution of the illness. Therefore, therapeutic attempts are being made to decrease the replication in order to favorably influence the development. Treatment of PHI is considered urgent in hope of limiting both the spread of the virus throughout the body and the establishment of viral reservoirs that are subsequently difficult to attain. Thus, the progressive destruction of the immune system, one of the characteristics of HIV infection, could be prevented through treatment.
Keywords : HIV – Primary-infection – Treatment.
Pictures
Figure 1. Événements précoces de l'infection
transmucosale par le VIH-1 (d'après Kahnet al. [4]).
Figure 2. Dynamique des
marqueurs viraux et immunologiques au cours de la primo-infection à
VIH en l'absence de traitement (d'après Busch et al. [5]).
Figure 3. Évolution vers le
sida et la mort selon le point d'équilibre (setpoint) après
la primo-infection en l'absence de traitment (d'après Mellors et
al. [10]).
Tableau 1. Manifestations
cliniques plus rares décrites lors de la PIVS dans la littérature
Printable version
