Primary HIV infection.

Acute human immunodeficiency virus (HIV) infection, referred to as primary HIV infection (PHI), is associated in the majority of patients with an acute retroviral syndrome presenting similarities with infectious mononucleosis and an exponential rise in viral titres. Symptoms rapidly amend and viraemia levels decline spontaneously to reach a set point at 6 months. The intensity of the acute retroviral syndrome and viraemia levels at set point are predictive of HIV disease progression. There are a number of arguments favouring initiation of treatment at the time of PHI (homogeneity of viral populations, preservation of the immune system, prevention of virus spreading) but these arguments should be weighted against parameters more difficult to evaluate such as long-term drug-associated toxicities and adherence. In clinical practice, adherence is closely linked to the patient's commitment, which is the key parameter for treatment decision.