Page 120 - HIV/AIDS Guidelines

Table 10. Identifying, Diagnosing, and Managing Acute HIV-1 Infection

• Suspecting acute HIV infection: Signs or symptoms of acute HIV infection with recent (within 2–6 weeks) high risk of exposure
to HIV a
• Signs/symptoms/laboratory findings may include but are not limited to one or more of the following: fever,
lymphadenopathy, skin rash, myalgia/arthralgia, headache, diarrhea, oral ulcers, leucopenia, thrombocytopenia,
transaminase elevation.
• High-risk exposures include sexual contact with a person infected with HIV or at risk of HIV, sharing of injection drug use
paraphernalia, or contact of potentially infectious blood with mucous membranes or breaks in skin. a
• Differential diagnosis: Epstein-Barr virus (EBV)- and non-EBV (e.g., cytomegalovirus [CMV])-related infectious mononucleosis
syndromes, influenza, viral hepatitis, streptococcal infection, syphilis
• Evaluation/diagnosis of acute/primary HIV infection
• HIV antibody enzyme immunoassay (EIA) (rapid test if available)
- Reactive EIA must be followed by Western blot.
- Negative EIA or reactive EIA with negative or indeterminate Western blot should be followed by a virologic test. b
b
• Positive virologic test in this setting is consistent with acute HIV infection.
• When acute HIV infection is diagnosed by a positive virologic test (such as HIV RNA or p24 antigen) that was preceded by
a negative HIV antibody test, a confirmatory HIV antibody test should be performed over the next 3 months to confirm
seroconversion.
• Considerations for antiretroviral therapy:
• All pregnant women with acute or recent HIV infection should start on a combination ARV regimen as soon as possible
because of the high risk of MTCT of HIV (AI).
• Treatment of acute and early HIV infection in nonpregnant persons is considered optional (CIII).
• Potentially unique benefits associated with ART during acute and early infection exist, although they remain unproven.
• The risks of ART during acute and early infection are consistent with those for initiating ART in chronically infected
asymptomatic patients with high CD4 counts.
• If therapy is initiated, the goal should be for maintenance of maximal viral suppression.
• Enrollment in a clinical trial should be considered.

a In some settings, behaviors conducive to acquisition of HIV infection might not be ascertained or might not be perceived as “high risk” by
the health care provider or the patient or both. Thus, symptoms and signs consistent with acute retroviral syndrome should motivate
consideration of this diagnosis even in the absence of reported high-risk behaviors.
b p24 antigen or HIV RNA assay. The p24 antigen is less sensitive but more specific than HIV RNA tests; HIV RNA tests are generally
preferred. HIV RNA tests include quantitative branched DNA (bDNA), reverse transcriptase-polymerase chain reaction (RT-PCR), or
qualitative transcription-mediated amplification (APTIMA, GenProbe).

References

1. Tindall B, Cooper DA. Primary HIV infection: host responses and intervention strategies. AIDS. 1991;5(1):1-14.
2. Niu MT, Stein DS, Schnittman SM. Primary human immunodeficiency virus type 1 infection: review of pathogenesis
and early treatment intervention in humans and animal retrovirus infections. J Infect Dis. 1993;168(6):1490-1501.
3. Kinloch-de Loes S, de Saussure P, Saurat JH, et al. Symptomatic primary infection due to human immunodeficiency
virus type 1: review of 31 cases. Clin Infect Dis. 1993;17(1):59-65.
4. Schacker T, Collier AC, Hughes J, et al. Clinical and epidemiologic features of primary HIV infection. Ann Intern Med.
1996;125(4):257-264.
5. Daar ES, Little S, Pitt J, et al. Diagnosis of primary HIV-1 infection. Los Angeles County Primary HIV Infection
Recruitment Network. Ann Intern Med. 2001;134(1):25-29.

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents I-4

Downloaded from http://aidsinfo.nih.gov/guidelines on 12/8/2012 EST.