Overall there was a modest benefit in terms

of delaying the decline in CD4 cell count, or time from seroconversion, to requiring initiation of lifelong ART following a 48- [16] or 60- [15] week course of ART. A post hoc analysis from the SPARTAC RG7204 clinical trial trial [16] showed a non-significant trend towards benefit in time to CD4 cell count <350 cells/μL when ART was initiated closer to the time of infection (HR 0.48; P = 0.09). This randomized study supported cohort studies in which a more rapid rate of CD4 cell loss was seen in individuals presenting within 12 weeks of a negative HIV antibody test [17, 18]. For this reason, we suggest that the following are discussed with those presenting with a very short

test interval (≤12 weeks), in particular, those with severe symptoms of seroconversion such as rash, fever, weight loss, persistent lymphadenopathy, diarrhoea >4 days, malaise, headaches or laboratory evidence of acute HIV infection (e.g. as defined in SPARTAC [16]). A 48-week course of ART showed a benefit in surrogate markers of HIV-disease progression: delaying CD4 decline and lowering viral set point up to 60 weeks after stopping therapy. There was no such benefit from 12 weeks of ART. In those individuals presenting within 12 weeks of infection, this effect was more marked; however, there is no clear evidence of long-term clinical benefit of ART in this setting. No study has learn more examined whether ART started during, or soon after, PHI should be continued long term, but most clinicians

would recommend that irrespective of indication to start ART, once initiated, it should be continued indefinitely. Discontinuation of ART in the context of treatment of PHI was not commonly associated with morbidity, however [15, 16]. Initiation of a PI-based regimen is recommended if therapy is started before the availability of a genotype result, based on the prevalence of transmitted rates of drug resistance in the UK [19]. There is no specific evidence to support the role of ART in PHI to prevent onward transmission of virus but there is little reason to consider that ART is any less effective in reducing infectivity at this time, so long as viral suppression has been achieved [20]. Patients with recently diagnosed PHI may be in a Sclareol particularly vulnerable psychological state, and thus ill-prepared to commit to starting long-term treatment. We recommend the evidence that treatment with ART lowers the risk of transmission is discussed with all patients, and an assessment of the current risk of transmission to others is made at the time of this discussion (GPP). We recommend following discussion, if a patient with a CD4 cell count >350 cells/μL wishes to start ART to reduce the risk of transmission to partners, this decision is respected and ART is started (GPP).