TABLE 1.

Identifying and Diagnosing Acute and Recent HIV-1 Infection

Suspicion of acute HIV-1 infection

Acute HIV-1 infection should be considered in individuals with signs or symptoms described below and recent (within 2 to 6 wk) high risk of exposure to HIV-1.a

Signs, symptoms, or laboratory findings of acute HIV-1 infection 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 who has HIV-1 infection or a person at risk for HIV-1 infection, sharing of injection drug use paraphernalia, or any exposure in which an individual’s mucous membranes or breaks in the skin come in contact with bodily fluid potentially infected with HIV.

Differential diagnosis: The differential diagnosis of HIV-1 infection may include but is not limited to viral illnesses such as EBV and non-EBV (eg, cytomegalovirus) infectious mononucleosis syndromes, influenza, viral hepatitis, streptococcal infection, or syphilis.

Evaluation and diagnosis of acute HIV-1 infection

Acute HIV-1 infection is defined as detectable HIV-1 RNA or p24 antigen (the antigen used in currently available HIV Ag/Ab combination assays) in the setting of a negative or indeterminate HIV-1 antibody test result.

A reactive HIV antibody test result or Ag/Ab combination test result must be followed by supplemental confirmatory testing.

A negative or indeterminate HIV-1 antibody test result in a person with a reactive Ag/Ab test result or in whom acute HIV-1 infection is suspected requires plasma HIV-1 RNA testing to diagnose acute HIV-1 infection.

A positive result on a quantitative or qualitative plasma HIV-1 RNA test in the setting of a negative or indeterminate antibody test result indicates that acute HIV-1 infection is highly likely, in which case, the diagnosis of HIV-1 infection should be later confirmed by subsequent documentation of HIV antibody seroconversion.

Information from Panel on Antiretroviral Guidelines for Adults and Adolescents.⁵⁶ Ab, antibody; Ag, antigen; EBV, Epstein-Barr virus.

^aIn some settings, behaviors that increase the risk of HIV-1 infection may not be recognized or perceived as risky by the health care provider or the patient, or both. Thus, even in the absence of reported high-risk behaviors, symptoms and signs consistent with acute retroviral syndrome should motivate practitioners to consider a diagnosis of acute HIV-1 infection.