LAUSR

Identifying and treating HIV during the initial phase of infection reusing PCR-array to identify a differentially expressed subset of 17 mains challenging. During the early phase of infection, HIV is most transmissible due to high viral load in plasma and mucosal secretions and quickly establishes a latent reservoir, which prevails over conventional approaches to cure through antiviral treatment [1]. Timely diagnosis of HIV providesmultiple benefits at both individual and the population level. Initiation of ART during the initial phase of infection has been shown to preserve immune function in the blood and in mucosal tissues, such as the gut [2], a major site of the latent HIV reservoir. Early awareness of HIV status may help to reduce transmission, both by curtailing individual risk behaviors and through early administration of ART. These interventions, in turn, can help to reduce viremic load, as individuals with undetectable plasma HIV are not known to transmit the virus [3,4]. A highly sensitive and specific assay that uses a simple nucleic acid quantification method to accurately diagnose an early HIV infection, in those who show below the detection threshold of plasma HIV RNA will provide improvement in HIV diagnostics. Increasingly, the widespread use of pre-exposure prophylaxis (PrEP) has created additional diagnostic challenges, as individuals with early HIV infection who remain on continuous or intermittent PrEP have different kinetics of HIV plasma RNA levels and may have a more prolonged window of undetectability than the standard eclipse phase. Antibody-based PrEP directed against HIV envelope may remove virions from plasma but fail to prevent infection. Because HIV may remain undetectable for longer periods in the setting of PrEP, the half-life of these circulating miRNAs will need to be more closely defined and may be influenced by the percentage that is encapsulated into microvesicles or exosomes. In an article in EBioMedicine, Biswas and colleagues utilize a novel approach to diagnose an early HIV infection through the identification of circulating microRNAs (miRNA) [5]. These are small non-coding RNAs present in extracellular circulation, which can reside in microvesicles, exosomes, and microparticles. By utilizing plasma samples from three independent HIV-1 infected patients collected at different stages during the early phase of infection (including three RNA+, three Ag+, and three from Ag + Ab+/seroconverted) in relation to three healthy controls, the authors analyzed 372 circulating miRNAs