Acute HIV Infection

Background

• Acute HIV infection is defined as the interval between the appearance of HIV RNA in the plasma and the detection of HIV-specific antibodies.
• Acute retroviral syndrome refers to the clinical syndrome associated with acute HIV infection.
  • The precise proportion of patients who develop symptomatic versus subclinical infection is not known but estimates range from 40% to 92%.
  • When present, symptoms may mimic a mononucleosis-like syndrome commonly characterized by:
    • constitutional symptoms such as fever and fatigue
    • pharyngitis
    • rash
    • myalgias and arthralgias
    • night sweats
  • Symptoms of acute HIV infection are usually self-limited
• As symptoms are nonspecific, a high degree of suspicion is needed to make the diagnosis.

Evaluation

• A diagnosis of acute HIV infection is based on:
  • the detection of HIV in plasma by
    • HIV-1 RNA nucleic acid amplification testing (test of choice) or
    • p24 antigen assay
  • the absence of HIV seroconversion (either negative enzyme-linked immunosorbent assay [ELISA] or reactive ELISA plus negative or indeterminate Western blot)
• Newer 4th generation HIV antigen/antibody assays can detect a substantial proportion of acute infections that may be HIV antibody negative.

Management

• Treatment of acute HIV infection:
  • may lead to earlier and more complete recovery of the CD4 T-cell count
  • may lead to a decreased transmission rate, by decreasing the viral load level
• Antiretroviral therapy is recommended for all patients with HIV, including those with early infection (Strong recommendation).
• Pregnant women should start antiretroviral therapy to suppress viral load and prevent perinatal transmission (Strong recommendation).
• Preferred treatment options are the same as for patients with chronic HIV infection.