People who know me will know that this is a particular interest of mine. There are a number of posters focusing on the role of very early infection in onward transmission of HIV and it has been mentioned by a number of speakers.You can access the poster abstracts from the CROI Website but I will give you a few points about particularly interesting ones here.
Poster 1107 A French analysis of genotypic profiles for 987 patients between 1999 and 2010. Identified manyclustered transmission ranging up to 24 months, Often associated with younger MSM, while 54% were in Paris, 19 or 56 were in distant French regions and 13 of the 19 involved at least one person from Paris. Their conclusion is that primary HIV infection is a significant source of onward transmission especially in MSM and contributed to regional as well as Paris-base infections.
Poster 557 Acute infection would be missed in a small but important number of cases using Architect HIV Ab+ p24 Combo. 5 of 14 early not detected. Interestingly this 5 were in ramping up fase and had distinguishably different HIV dynamics. The do an analysis of cost on the basis of onward infections and argue the case for HIV NAAT.
Poster 552 Chance of transmission in early HIV infection 13 x higher via UAI. In a San Francisco sample early is considered less than 100 days. Gay men with acute infection comprise 2% of the infeted population (49% untreated and 49% on treatment) but account for 22% of new infections.