Question | Discussion | References | CME Credit

Updated November 22, 2010

Case 1: Acute (Primary) HIV Infection

Author: David H. Spach, MD

A 27-year-old previously healthy man presents to an urgent care center with fever, sore throat, lymphadenopathy, severe fatigue, and a diffuse erythematous rash. His symptoms have been present for approximately 48 hours and his history reveals unprotected receptive anal intercourse with another man 12 days prior to the onset of his symptoms. He had a negative HIV antibody test approximately 6 months ago. His physical examination shows a temperature of 39.0°C, non-exudative pharyngitis, cervical and axillary lymphadenopathy, and a generalized morbilliform rash (Figure 1). All laboratory tests are pending. The diagnosis of acute (primary) HIV infection is suspected.

Which one of the following statement is TRUE regarding acute HIV infection?

A Less than 5% of persons who acquire HIV develop an acute clinical illness.
B More than 80% of patients with acute HIV present with aseptic meningitis.
C Patients recently infected with HIV typically have plasma HIV RNA levels greater than 50,000 copies/ml within 4 weeks of acquiring HIV.
D An HIV RNA level of 120,00 copies/ml combined with a positive HIV antibody test would be diagnostic of acute HIV infection.

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    Figure 1. Morbilliform Rash

    This patient presented with a macular rash most prominent on the neck, chest, back, and abdominal region. The numerous lesions were flat, erythematous, and non-blanching.

    Figure 1