EARLY INTERVENTION FOR PERSONS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS

Early intervention for persons infected with human immunodeficiency virus (HIV) involves characterization of the stage of HIV disease, institution of therapy to prevent associated infections and postpone deterioration of immune function, and assistance in preventing transmission of the virus. This review examines the available data on the efficacy of current recommendations regarding the evaluation and management of persons with early HIV infection. Existing evidence supports the efficacy of physical examination, monitoring of the CD4(+) cell count, tuberculin testing (with chemotherapy for persons who test positive), anergy testing, Papanicolaou testing and screening for gonorrhea and chlamydial infection (for high-risk women), screening for syphilis, antiretroviral therapy (for symptomatic patients), and guidance in reducing the transmission of HIV. Recommended measures for which evidence of clinical efficacy is less certain include immunization against infections due to influenza virus, Streptococcus pneumoniae, Haemophilus influenzae, and hepatitis B virus as well as antiretroviral therapy for asymptomatic persons. Quantitative measurement of viral titers appears promising for the monitoring of HIV disease and antiretroviral therapy; the correlations of these titers with clinical end points need to be confirmed.