Brief Report: Blood and Genital Fluid Viral Load Trajectories Among Treated and Untreated Persons With Acute HIV Infection in Malawi

BACKGROUND: Persons with acute HIV infection (AHI) are highly infectious and responsible for a disproportionate share of incident infections. Immediate antiretroviral therapy (ART) rapidly reduces blood viral loads (VL), but genital VLs after ART initiation during AHI are less well described. SETTING: Lilongwe, Malawi, 2012–2014. METHODS: HIV-seronegative and -serodiscordant persons ≥18 years were screened for AHI (RNA positive), and randomized to standard care, behavioral intervention, or behavioral intervention plus short-term ART (raltegravir/emtricitabine/tenofovir) (1:2:2). Persons who were ART eligible under Malawi guidelines could receive first-line therapy. Blood and genital VLs were assessed at weeks 1, 4, 8, and 12. Fisher’s Exact test was used to compare viral suppression by ART status. RESULTS: 46 persons with AHI enrolled, 17 of whom started ART within 12 weeks. Median blood VL at AHI diagnosis was 836,115 copies/mL. At week 12, 7% (1/14) of those who initiated ART had a blood VL ≥400 copies/mL, compared to 100% (23/23; p