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Primary HIV Infection

Acute retroviral syndrome occurs at the time the infection is acquired in 60% to 80% of HIV-infected persons. The illness resembles infectious mononucleosis from infection with Epstein-Barr virus (EBV), and acute retroviral syndrome is a consideration in differential diagnosis of heterophil-negative mononucleosis. Risk factors for transmission of HIV include history of

Clinical signs and symptoms

The period between acquisition of HIV and onset of symptoms is about 14 days, and the characteristic signs and symptoms range from a mild fever and sore throat to a severe mononucleosis-type syndrome with

In those patients with symptomatic seroconversion, the five most common signs and symptoms are fever, fatigue, pharyngitis, weight loss, and myalgias. Characteristic symptoms of acute retroviral syndrome occur in

Laboratory features

Primary HIV infection is diagnosed by a positive plasma HIV RNA obtained on the same day as a negative Western blot assay. If the interval between onset of symptoms and ordering of the HIV RNA test and Western blot assay is prolonged, both tests will be positive, suggesting that the patient has been infected with HIV for

Clinical evaluation of possible primary HIV infection often includes a heterophil antibody (Monospot) test to rule out EBV mononucleosis, cytomegalovirus antigen or antibody, acute and convalescent serologic tests for rubella and toxoplasmosis, rapid plasma reagin test, Western blot assay for herpes simplex virus, and serologic tests for hepatitis (including hepatitis C virus RNA polymerase chain reaction). Because up to 30% of

Initial management