ArticleLancet (London, England)2011
The role of acute and early HIV infection in the spread of HIV and implications for transmission prevention strategies in Lilongwe, Malawi: a modelling study.
Article in Lancet (London, England), 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 189 papers, 3 of them syntheses that pooled it.
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Who cites it
189 citing papers in PubMed, 3 syntheses or guidelines pooled it, 312 citations in OpenAlex.
- Acute and early HIV infection screening among men who have sex with men, a systematic review and meta-analysis.Journal of the International AIDS Society · 2020Pooled it
- Impact of viral load and the duration of primary infection on HIV transmission: systematic review and meta-analysis.AIDS (London, England) · 2014Pooled it
- Guideline
- A randomized controlled trial evaluating combination detection of HIV in Malawian sexually transmitted infections clinics.Journal of the International AIDS Society · 2021Trial
- Vaccine Efficacy of ALVAC-HIV and Bivalent Subtype C gp120-MF59 in Adults.The New England journal of medicine · 2021Trial
- Understanding of Perceived Infectiousness and Its Influence on Sexual Behavior Among Individuals With Acute HIV Infection in Lilongwe, Malawi (HPTN 062).AIDS education and prevention : official publication of the International Society for AIDS Education · 2020Trial
- Human Immunodeficiency Virus (HIV)-1 Transmission Among Persons With Acute HIV-1 Infection in Malawi: Demographic, Behavioral, and Phylogenetic Relationships.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2019Trial
- Sustained Sexual Behavior Change After Acute HIV Diagnosis in Malawi.Sexually transmitted diseases · 2018Trial
- HIV status disclosure during acute HIV infection in Malawi.PloS one · 2018Trial
- Design of the HPTN 065 (TLC-Plus) study: A study to evaluate the feasibility of an enhanced test, link-to-care, plus treat approach for HIV prevention in the United States.Clinical trials (London, England) · 2017Trial
- Impact of early cART on HIV blood and semen compartments at the time of primary infection.PloS one · 2017Trial
- Trial
- Anogenital HIV RNA in Thai men who have sex with men in Bangkok during acute HIV infection and after randomization to standard vs. intensified antiretroviral regimens.Journal of the International AIDS Society · 2015Trial
- Trial
- Trial
- Estimating the effectiveness in HIV prevention trials by incorporating the exposure process: application to HPTN 035 data.Biometrics · 2014Trial
- HPTN 062: a feasibility and acceptability pilot intervention to reduce HIV transmission risk behaviors among individuals with acute and early HIV infection in Lilongwe, Malawi.AIDS and behavior · 2014Trial
- High HIV Incidence Among HIV-Infected But Undetected Individuals Seeking HIV Voluntary Counselling and Testing Services in the Greater Masaka Region in Uganda.Journal of acquired immune deficiency syndromes (1999) · 2026Article
- Silent reservoir species are shaping the emergence of Usutu virus.Nature ecology & evolution · 2026Article
- A Four-Item Risk Score to Target Acute HIV Infection Testing Among Men Who Have Sex With Men in Indonesia: Development and Validation in the INTERACT Prospective Cohort.Journal of the International AIDS Society · 2026Article
129 more citing papers are in PubMed but not listed here.
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Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundHIV transmission risk is higher during acute and early HIV infection than it is during chronic infection, but the contribution of early infection to the spread of HIV is controversial. We estimated the contribution of early infection to HIV incidence in Lilongwe, Malawi, and predict the future effect of hypothetical prevention interventions targeted at early infection only, chronic infection only, or both stages.
methodsWe developed a deterministic mathematical model describing heterosexual HIV transmission, informed by detailed behavioural and viral-load data collected in Lilongwe. We included sexual contact within and outside of steady pairs and divided the infectious period into intervals to allow for changes in transmissibility by infection stage. We used a Bayesian melding approach to fit the model to HIV prevalence data collected between 1987 and 2005 at Lilongwe antenatal clinics. We assessed interventions that reduced the per-contact transmission probability to 0.00003 in people receiving them, and varied the proportion of individuals receiving the intervention in each stage.
findingsWe estimated that 38.4% (95% credible interval 18.6-52.3) of HIV transmissions in Lilongwe are attributable to sexual contact with individuals with early infection. Interventions targeted at only early infection substantially reduced HIV prevalence, but did not lead to elimination, even with 100% coverage. Interventions targeted at only chronic infections also reduced HIV prevalence, but coverage levels of 95-99% were needed for the elimination of HIV. In scenarios with less than 95% coverage of interventions targeted at chronic infections, additional interventions reaching 25-75% of individuals with early infection reduced HIV prevalence substantially.
interpretationOur results suggest that early infection plays an important part in HIV transmission in this sub-Saharan African setting. Without near-complete coverage, interventions during chronic infection will probably have incomplete effectiveness unless complemented by strategies targeting individuals with early HIV infection.
fundingNational Institutes of Health, University of North Carolina Center for AIDS Research.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.