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.