Diagnosis of Acute HIV Infection: It's Time To Get Moving!

• Human immunodeficiency virus infections
• Specialties, medical
• Diagnosis, laboratory
• False negative reactions
• False positive reactions

Despite dramatic advances in the treatment of HIV infection and the resultant decrease in deaths from AIDS, new HIV infections continue to occur among Americans at a relatively steady rate of 40 000 to 45 000 per year (1). More than 90% of cases of acute HIV infection go undiagnosed despite the fact that more than 50% of persons with the disease are symptomatic (2). Although many of these symptomatic patients seek medical attention at emergency departments, urgent care centers, and primary care offices, they often receive the true but highly misleading diagnosis of “viral syndrome” and are told to go home, take aspirin and plenty of fluids, and call if the symptoms do not resolve. Usually, the symptoms do resolve. Acute infection occasionally has severe sequelae, which may include neurologic syndromes (such as meningitis or myelopathies) or opportunistic infections caused by profound decreases in CD4 cell count (such as Pneumocystis carinii pneumonia [3] or Candida esophagitis).

Why have we, as a medical profession, been so lax in diagnosing acute HIV infection? There are two primary reasons. The first is that treatment and often diagnosis of HIV infection have been relegated to specialists. Sometimes this is due to lack of knowledge of newer tests or therapies, and sometimes it is due to discomfort related to the difficult issues surrounding HIV, such as high-risk sexual behavior and substance abuse. Sometimes it is simply caused by a clinician's inability to spend the additional time that the subject of HIV frequently requires. Relegating diagnosis and management of HIV infection to specialists has severely impaired our ability as a profession to diagnose this syndrome. Patients with primary HIV infection most often present to non–HIV specialists, such as dermatologists, emergency department physicians, or primary care physicians, with mononucleosis-like symptoms, including fever and myalgias. …