Acute Retroviral Syndrome Acute Retroviral Syndrome is the symptomatic presentation of acute human immunodeficiency virus infection • Presents as a mononucleosis/flu type of syndrome with a constellation of nonspecific symptoms • >50,000 HIV infections occur annually in the US • 10 to 60% - No symptoms • Time: 2-4 weeks from exposure to symptoms • May last days or weeks • Virus infects wide variety of tissues, seeds the lymphoid organs • Symptoms of primary HIV typically begin within 28 days of infection Acute Retroviral Syndrome Symptoms: • Headache (45%) • Fever (75%) • Encephalopathy (25%) • Fatigue (68%) • Lymphadenopathy (39%) • Photophobia (24%) • Mouth ulcers • Sore throat (40%) • Night sweats (28%) • Skin rash (48%) • Hepatomegaly - Liver enzyme elevation • Nausea, vomiting, diarrhea (27%) • Myalgias, Arthralgias (49%) • Weight loss (>5 lb; 2.5 kg) (32%) Atypical Presentations: • Opportunistic infections - rare during transient CD4 lymphopenia of early HIV infection - Most common: Oral and esophageal candidiasis • Central nervous system manifestations Labs: • CD4+ T-cell count can decrease (<200 cells per microliter or <14%), in which case opportunistic infections can develop • Viral RNA level ↑ • Leukocyte-lymphocyte subset counts ↓ • Liver enzymes ↑ • Mild anemia • Thrombocytopenia Neuro - Aseptic Meningitis: • >1 in 10 patients have symptoms • Severe headache, meningismus • Photophobia • Lymphocytic pleocytosis on cerebrospinal fluid DDX: • Epstein-Barr virus (EBV) • Cytomegalovirus (CMV) • Toxoplasmosis • Rubella • Syphilis • New onset SLE • Disseminated gonococcal infection • Viral hepatitis Diagnosis: Fourth-generation HIV-1/2 Immunoassay • Detects both HIV antibody and HIV p24 antigen • Identify acute/early infection in up to 80% of patients • HIV-1 p24 core Ag - Detects 17-20 days after exposure • Antibodies to HIV-1 and HIV-2 • HIV-1 RNA viral load Confirmatory Tests: • HIV-1/HIV-2 differentiation immunoassay • If differentiation IA is indeterminant - then an HIV Nucleic Acid test is necessary Eclipse Phase: • The short interval following HIV acquisition in which no diagnostic test is capable of detecting HIV for 10-12 days. • HIV RNA is the first test to detect HIV (10 days after initial HIV-1 acquisition,) • 17-20 days after exposure: HIV p24 antigen detected • 21 to 25 days after exposure, HIV-1 or HIV-2 antibodies can be detected (IgG/IgM-sensitive HIV-1 antibody test) Treatment: • ART to slow HIV disease progression by slowing CD4 decline and reducing HIV RNA levels. #Acute #Retroviral #Syndrome #HIV #diagnosis
