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To the Editor: The concept that peak viremia during primary human immunodeficiency virus (HIV) infection (PHI) could be associated with concurrent high-level genital shedding^1-2 has led to the hypothesis that individuals with PHI are highly infectious. This hypothesis would in part explain rapid epidemic spread in populations³ and would suggest that PHI is an important target for public health intervention. We sought to establish that such transmission occurs and to examine the window of infectiousness during PHI.

Methods

We investigated 5 cases drawn from 4 university hospital clinics, in whom sexual transmission was suspected to have occurred between an individual with documented PHI and a sexual partner who later developed documented PHI. We defined PHI as p24 antigen positivity, RNA and/or DNA positivity, enzyme-linked immunosorbent assay negativity, or 2 or fewer bands on Western blot within 30 days. Other risk factors for transmission were excluded. Each transmission pair was confirmed by . . . [Full Text of this Article]

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