Recognizing Acute HIV Syndrome

It is not uncommon for people to present at their doctor's office with such non-specific symptoms as fever, headache, muscle/joint aches, and sore throat. in many cases, it would be presumptively diagnosed as the flu, after which the patient would be sent home with pain relievers and advised to rest and drink plenty of fluids.

But when might these symptoms suggest something more? Might we (and our doctors) be misreading the clues by jumping to the first, albeit reasonable, diagnosis?

Today, we should always consider the possibility of HIV in those at high risk of infection, including men who have sex with men (MSM) and sexually active adolescents and young adults.

While the above-listed symptoms may not serve as obvious warning signs, they are the type of symptoms commonly seen in those with recent HIV infection (a state commonly referred to as either acute HIV syndrome, acute retroviral syndrome or acute seroconversion).

What Is Acute HIV Syndrome?

Acute HIV syndrome is the body's reaction to a new HIV infection, presents with symptom similar to that of flu or mononucleosis. It occurs in anywhere from 30-50% of newly infected individuals, with symptoms ranging from mild to severe.

The symptoms are the result of the body's aggressive activation of immune defense, in which pro-inflammatory enzymes and agents are produced as immune cells fight to neutralizing the viral invaders.

While it is understandable that a person might miss these signs when sitting in a doctor's office, there are occasionally clues that might suggest this is something more serious. Among them:

• The sudden appearance of painful, swollen lymph nodes
• A disseminated rash colloquially referred to as an HIV rash
• Diarrhea
• Recent high-risk sexual activity
• Recent shared injecting drug use

While none of these factors are in and of themselves a direct indication of HIV infection, they most certainly warrant closer investigation and diagnosis.

Why Identifying Acute HIV Is Important

First and foremost, early diagnosis of HIV provides a newly infected person with the opportunity of immediate antiretroviral therapy (ART). The early implementation of ART is associated with not only lower risk of illness but increases the likelihood of achieving near-normal to normal life spans in those infected.

Some research has also suggested that early intervention may slow disease progression by preventing the virus from establishing hidden reservoirs in the cells and tissues of the body. In doing so, the chronic inflammation associated with long-term infection may be reduced, lowering the risk of non-HIV-related comorbidities.

Diagnosis

Newer tests are better at diagnosing early HIV infection by detecting viral load when compared to antibody tests that miss as many as 90% of acute cases.

While there is still potential for misdiagnosis, some newer generation assays are able to confirm over 80% of new HIV infections.

What Needs to Be Done

While many might suggest that it's the doctor's role to diagnose, it's important that the patients participate by volunteering, fully and honestly, any practice that may have placed them at high risk of HIV. It's so perfectly reasonable to request an HIV test, which the U.S. Preventive Services Task Force recommends for all Americans age 15-65 as part of a routine doctor's visit.

Doctors and clinic staff should also be appraised of these guidelines and make it a practice to suggest HIV testing of their patients, particularly in communities with high HIV prevalence.