Case of the Month: Possible Acute HIV Infection

Case Summary
A doctor called the HIV/AIDS Management Service to ask about an 18-year-old male who had been diagnosed with syphilis and was presenting to clinic with low-grade fever, pharyngitis, and cervical adenopathy. The patient had had unprotected receptive anal intercourse with another male three to four weeks prior to the time of the call. An HIV antibody test that had been conducted 15 months earlier had been negative. The caller wanted advice on whether the patient’s current symptoms indicated an acute HIV infection.

CCC Consultant Advice
The CCC consultant agreed that the patient could potentially be in acute seroconversion based on the exposure date and symptoms presented; however, even if the patient is HIV-infected, an HIV antibody test could read positive or negative. An HIV viral load can be taken as well, with the caveat that there is a 3% false positive rate, especially if the patient’s viral load is less than 5,000-10,000. The consultant noted that if the current signs/symptoms are due to a primary HIV infection, a high viral load would be expected, likely much higher than 10,000. If upon completion of this initial round of testing the HIV antibody test is negative and the viral load is undetectable, a repeat HIV antibody test would be strongly recommended at about four weeks. The consultant advised the caller to call back for further advice on initiation of ARV treatment if necessary.

Because CCC consultations are based on information provided by the caller or clinician accessing the online consultation center, without the benefit of a direct evaluation or examination of the patient, consultations are intended to be used as a guide. They do not constitute medical advice and are not to serve as a substitute for medical judgment. This Case of the Month includes consultation based on the most up-to-date evidence at the time of its publication. To learn about current recommendations, please call one of our clinical consultation lines.