9.2 Notebook-annotated

the treatment of patients in the acute and early stage of hiv infection has long been a subject of intensive investigation. A handful of studies have evaluated immediate, short-term antiretroviral therapy— with and without structured treatment interruptions and/or immunebased therapies—during acute and early hiv infection in an effort to perturb the virus-host equilibrium, with the intent of achieving long-term virologic control in the absence of antiretroviral therapy. However, when it comes to this approach, there are still more questions than answers. But this is not to say that the identification and careful handling of individuals in the acute and early stages of hiv infection is not important. There are both established and potential benefits associated with the early diagnosis and management of acute hiv infection. And for the lingering questions to be answered correctly, clinical trials must continue, which requires clinicians to remain on their toes and to refer patients to ongoing studies in an effort to capitalize on what is still believed to be a potential window of opportunity. This article summarizes a lecture focusing on acute and early hiv diagnosis and treatment delivered in March by Dr. Markowitz. Also included in this review are much anticipated, albeit somewhat sobering, data from the Massachusetts General Hospital primary hiv infection structured treatment interruption study, presented by Dr. Bruce Walker, initially at the 11th Conference on Retroviruses and Opportunistic Infections (croi) and more recently at the April 2004 prn meeting.