Thursday, September 17, 2015

Acute HIV Infection- Clinical Symptoms Are Not Reliable

If clinicians feel that they can rely on typical symptoms of acute HIV infection to trigger an HIV PCR test for diagnosis, think again.

Here is a intriguing read published in Clinical Infectious Diseases this month. The investigators review 290 patients (271 males) with primary HIV infection- seroconversion. The majority (70%) had typical symptoms of acute HIV infection, including fever. A significant chunk, 30%, manifested no fever and had atypical presentations, including non-specific neurologic ( encephalitis, prolonged vertigo, paresthesias) and gastrointestinal symptoms (diarrhea, tonsillitis, severe gastritis).  In the study cohort, only in 112 (38%) patients was HIV infection suspected during the first medical attendance. Opportunities to diagnose HIV were missed


The utility of a clinical evaluation to rule out acute HIV infection is limited. 

To me, the message is clear: have a low threshold to test for HIV.

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