"The majority of people with acute HIV infection
will have some sort of symptoms of an acute viral syndrome.
signs/symptoms 5 (3-6); NS in those symptomatic, n = 37 median (IQR) Duration of symptoms, d, 6 (3-9); <0.01 median (IQR) n = 36 CD4+ cell count, cells/ 445 (295-610) NS [micro]L, median (IQR) Viral load, [log.sub.10] 5.0 (3.8-6.1) 0.07 RNA, median (IQR) * AHI, acute HIV infection
; IQR, interquartile range; NAT, nucleic acid amplification testing; NS, not significant.
CDC PrEP guidelines stress that PrEP candidates must have a documented negative HIV antibody test "immediately before starting PrEP medication." (9,11) Providers should also look for signals of acute HIV infection
, which may not register on a standard antibody test.
Such combined tests have been demonstrated to increase the rate of diagnosis of acute HIV infection
by a factor of 1.5 when compared to third-generation tests.
Indeed, 25%-50% of those with acute HIV infection
present with viral meningitis.
In acute HIV infection
, the virus migrates to lymphoid organs, where it causes reactive lymphadenitis.
Acute HIV infection
was first described in 1985 as a mononucleosis-like illness (Altfeld & Walker, 2005).
Almost 1 in 40 of those who tested HIV negative in a large clinic cohort in Lilongwe, Malawi, turned out to have acute HIV infection
that was too recent to be detected by single or dual rapid antibody test used as the standard method of HIV diagnosis, researchers from the University of North Carolina report in a recent edition of the Journal of Infectious Diseases.
Guidelines from the Department of Health and Human Services recommend resistance tests in the clinical setting in cases of virologic failure, suboptimal virologic suppression, and acute HIV infection
To confirm an acute HIV infection
in symptomatic individuals with potential HIV risk factors, current guidelines (2) recommend use of HIV RNA (viral load) tests.
The transition to use of a fourth-generation HIV immunoassay for HIV screening throughout the DoD has substantially reduced the failure to diagnose acute HIV infection
during the "window period" (i.e., the time between exposure to HIV infection and appearance of the first detectable HIV RNA).
Acute HIV infection
detection and immediate treatment estimated to reduce transmission by 89% among men who have sex with men in Bangkok.