title: Positive Epstein-Barr virus heterophile antibody tests in patients with primary human immunodeficiency virus infection.
abstract: OBJECTIVE
  To describe three cases of primary human immunodeficiency virus (HIV) infection in patients who had laboratory studies consistent with infectious mononucleosis.
  
  
  METHODS
  We describe 3 patients who presented with a viral syndrome, had a positive heterophile antibody test, and were diagnosed with primary HIV infection.
  
  
  RESULTS
  The results of Epstein-Barr virus serology studies in each of these patients were consistent with chronic, but not acute, Epstein-Barr virus infection. HIV antibody tests were negative, and HIV RNA was >500,000 copies/mL in each patient.
  
  
  CONCLUSIONS
  Clinicians should recognize that a positive heterophile antibody test in the setting of an acute viral illness does not exclude the diagnosis of primary HIV infection, although reactivation of latent Epstein-Barr virus infection cannot be ruled out. Patients presenting with nonspecific viral syndromes should be assessed for HIV risk behaviors and tested for primary HIV infection when appropriate.
authors.affiliation: Department of Medicine, Section of General Internal Medicine and Clinical AIDS Program, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Vidrih
authors.forename: R P
authors.initials: RP
authors.lastname: Walensky
authors.forename: P E
authors.initials: PE
authors.lastname: Sax
authors.forename: K A
authors.initials: KA
authors.lastname: Freedberg
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000276:immunology; D000328:Adult; D000910:Antibodies, Heterophile / Q000097:blood*; D000914:Antibodies, Viral / Q000097:blood*; D018791:CD4 Lymphocyte Count; D005260:Female; D015483:HIV Antibodies / Q000097:blood; D004854:Herpesvirus 4, Human / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007244:Infectious Mononucleosis / Q000175:diagnosis* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D013997:Time Factors
chemical_list: D000910:Antibodies, Heterophile; D000914:Antibodies, Viral; D015483:HIV Antibodies; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012367:RNA, Viral