BC Centre in HIV/AIDS Primary Care Guidelines

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3 Acute HIV Infection

Definition

  • Also known as acute retroviral syndrome, acute HIV seroconversion or primary HIV infection.

  • Acute HIV infection is defined as the period between exposure to the virus and completion of the initial immune responses. During this time, antibody tests may be negative for HIV, but the serum viral load (the amount of HIV virus in the blood) is detectable and can be quite high (millions of copies per milliliter).

  • Up to 50% of HIV transmission can occur during this acute HIV infection. It is critical that primary care providers maintain a high level of suspicion, since early diagnosis can:

    • Provide an opportunity to engage patients in care early in the disease

    • Prevent further HIV transmission by reducing risk behaviours and early initiation of treatments

  • The mean time from HIV exposure to onset of acute seroconversion illness is generally 2 – 4 weeks, although only an estimated 34% of HIV+ individuals will experience symptoms of seroconversion illness.

Signs and symptoms

Fever 80%
Tired or fatigued 78%
Malaise 68%
Arthralgias 54%
Headache 54%
Loss of appetite 54%
Rash 51%
Night sweats 51%
Myalgias 49%
Nausea 49%
Diarrhea 46%
Fever and rash 46%
Pharyngitis 44%
Oral ulcers 37%
Stiff neck 34%
Weight loss (>5 lbs; 2.5 kg) 32%
Confusion 25%
Photophobia 24%
Vomiting 12%
Infected gums 10%
Sores on anus 5%
Sores on genitals 2%

Diagnostic Tests

A laboratory diagnosis of acute HIV infection is based on the interpretation of a series of HIV tests of differing window periods, and reported as “findings suggestive of acute infection.”

IN BC all samples submitted for HIV serology are screened by the fourth generation EIA. Any reactivity on the screening EIA will automatically lead to a series of additional tests to help differentiate acute HIV infection from established HIV infection or a false positive HIV test.

Window Periods for Specific tests

Use the following tool to determine a test's usefulness at a particular point in time. A full gauge (circle) indicates that the test will work accurately to diagnose an HIV+ patient. An empty gauge indicates that the test will fail. A partial gauge indicates that the test has a proportional possibility of working accurately.

  • Seroconversion symptoms

    7

    10

    20

    30

  • 3rd Generation EIA

    20

    22

  • 4th Generation EIA

    16

    18

  • Western Blot

    27

    64

  • Individual RNA NAAT

    6

    8

  • Point-of-Care HIV Test

    20

    27

  • Pooled RNA NAAT

    10

    11.5

Management

  • Counselling
    • Offer assistance to patients in notifying their sexual partners.

    • Inform patients about increase of HIV transmission during acute HIV infection.

    • HIV infection is a reportable disease in BC. See BCCDC Surveillance Forms.

    • Your local public health office or Communicable Disease Program will provide assistance with contact tracing. (See also: ImmunizeBC Public Health Unit Finder)

  • ARV treatment
    • ARV therapy should be offered to all patients presenting with symptomatic seroconversion.

    • For asymptomatic seroconversion, the same principles outlined for chronic infection should be followed.

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