Volume 5, Issue 1, Pages e35-e44 (January 2018) Detection and treatment of Fiebig stage I HIV-1 infection in young at-risk women in South Africa: a prospective cohort study  Krista L Dong, MD, Amber Moodley, MPH, Douglas S Kwon, MD, Musie S Ghebremichael, PhD, Mary Dong, BSc, Nasreen Ismail, MMSc, Zaza M Ndhlovu, PhD, Jenniffer M Mabuka, PhD, Daniel M Muema, PhD, Karyn Pretorius, MSc, Nina Lin, MD, Bruce D Walker, MD, Prof Thumbi Ndung'u, PhD  The Lancet HIV  Volume 5, Issue 1, Pages e35-e44 (January 2018) DOI: 10.1016/S2352-3018(17)30146-7 Copyright © 2018 Elsevier Ltd Terms and Conditions

Figure 1 Study profile ART=combination antiretroviral therapy. *Early ART was defined as treatment initiated during acute HIV infection, immediately after detection of HIV RNA. The Lancet HIV 2018 5, e35-e44DOI: (10.1016/S2352-3018(17)30146-7) Copyright © 2018 Elsevier Ltd Terms and Conditions

Figure 2 Effect of early treatment on viral load and CD4 cell dynamics in acute HIV infection (A) The plasma viral load for 14 participants untreated during acute HIV infection is plotted against days after detection of HIV-1 RNA, with day 0 being the day of detection. (B) Effect of ART on viral load for 28 participants initiated on treatment immediately after detection of HIV-1 RNA; the horizontal boxes show median time to viral suppression (<20 copies per mL) for Fiebig stage I (16 days, IQR 12–26, range 6–78) versus Fiebig stage II–V (25 days, 19–38, 9–72). (C) Effect of immediate ART on viral-load dynamics in 23 participants with Fiebig stage I acute HIV infection compared with 13 untreated women with Fiebig stage I infection; median viral load is plotted against longitudinal sampling timepoints; the vertical bars on each curve represent the range for viral load at each timepoint. (D) Reduction of peak HIV viraemia by immediate initiation of ART in participants detected during Fiebig stage I acute HIV infection; median peak viral load (bold lines) and IQR (thin lines) are shown for 13 untreated (median 7·11 log10 copies per mL, IQR 6·98–7·48) and 23 early treated (4·22 log10 copies per mL, 3·27–4·83) participants (p<0·0001). (E) Dynamics of the CD4 cell count for 13 untreated and 23 early treated participants with Fiebig stage I acute HIV infection; pre-infection CD4 was the absolute CD4 cell count from the sampling point preceding detection of acute HIV infection; nadir CD4 was the lowest absolute CD4 cell count measured after detection of infection; rebound CD4 cell count was the absolute count collected at the scheduled 42 days sampling point. ART=combination antiretroviral therapy. The Lancet HIV 2018 5, e35-e44DOI: (10.1016/S2352-3018(17)30146-7) Copyright © 2018 Elsevier Ltd Terms and Conditions

Figure 3 Effect of ART initiated during acute HIV infection on western blot development Longitudinal western-blot testing is shown for 36 participants with Fiebig stage I HIV infection, of whom 13 were untreated and 23 received immediate ART. *Fiebig stage III. †Fiebig stage V. The Lancet HIV 2018 5, e35-e44DOI: (10.1016/S2352-3018(17)30146-7) Copyright © 2018 Elsevier Ltd Terms and Conditions