Primary HIV-1 infection--a "window of opportunity" for healthcare providers.
The diagnosis of primary HIV-1 infection (PHI) is often missed and requires a high index of suspicion and a thorough knowledge of laboratory methods. We report the case of a young promiscuous male who presented with fever, rash and neurological symptoms 8 weeks after unprotected sexual exposure. Clinical and laboratory investigations showed the presence of leucopenia and thrombocytopenia with elevated transaminases, and a normal cerebrospinal fluid analysis, while CNS imaging revealed a vasculitis-like involvement of the corpus callosum. Symptoms resolved spontaneously over 3 weeks. Fourth generation ELISA with p24 antigen assay was positive with high HIV-1 RNA load while Western-Blot was negative, thus confirming the diagnosis of PHI. The patient was subsequently started on antiretroviral therapy (ART) and showed undetectable viral load after 8 weeks of therapy. We present the differential diagnoses which need to be entertained as well as the pros and cons of very early ART intervention.
Maniar
A J
AJ
HIV Trials Unit, Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, USA.
Maniar
J K
JK
Kamath
R
R
Shah
S
S
Verma
Reena
R
Kinloch
Sabine
S
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D015497:HIV-1 / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D012313:RNA / Q000032:analysis
D019380:Anti-HIV Agents; D018501:Antirheumatic Agents; D012313:RNA