Probability of HIV transmission during acute infection in Rakai, Uganda.

Accurate estimates of the probability of HIV transmission during various stages of infection are needed to inform epidemiological models. Very limited information is available about the probability of transmission during acute HIV infection. We conducted a secondary analysis of published data from the Rakai, Uganda seroconversion study. Mathematical and computer-based models were used to quantify the per-act and per-partnership transmission probabilities during acute and chronic HIV infection, and to estimate how many of the transmission events reported in the Rakai study were due to acute-phase HIV transmission. The average per-act transmission probability during acute infection equaled 0.03604 vs. 0.00084 for chronic HIV infection. Overall, HIV was transmitted during acute infection in 46.5% of 23 "incident index partner couples." Acute-phase transmission accounted for 89.1% of all transmission events in the first 20 months of follow-up. These results highlight the substantial risk of transmission during acute HIV infection.