Identifying and Diagnosing Acute HIV-1 Infection

Suspecting acute HIV infection: signs or symptoms of acute HIV infection with recent (within 2–6 wk) high HIV risk exposurea
    Signs/symptoms/laboratory findings can include but are not limited to ≥1 of the following: fever, lymphadenopathy, skin rash, myalgia/arthralgia, headache, diarrhea, oral ulcers, leucopenia, thrombocytopenia, transaminase elevation, aseptic meningitis
    High-risk exposures include sexual contact with a person infected with HIV or at risk of HIV, sharing of injection drug use paraphernalia, or contact of potentially infectious blood with mucous membranes or breaks in skina
Differential diagnosis: EBV and non-EBV (eg, CMV)–related infectious mononucleosis syndromes, influenza, viral hepatitis, streptococcal infection, syphilis
Evaluation/diagnosis of acute/primary HIV infection
    HIV antibody EIA (rapid test if available)
        Reactive EIA must be followed by Western blot
        Negative EIA result or reactive EIA with negative or indeterminate Western blot should be followed by a virologic testb
    A positive virologic test result in this setting is consistent with acute HIV infection
    Positive quantitative or qualitative HIV RNA test results should be confirmed with subsequent documentation of seroconversion
  • EBV indicates Epstein-Barr virus; CMV, cytomegalovirus.

  • a In some settings, behaviors conducive to acquisition of HIV infection might not be ascertained or might not be perceived as “high risk” by the health care provider, the patient, or both. Thus, symptoms and signs consistent with acute retroviral syndrome should motivate consideration of this diagnosis even in the absence of reported high-risk behaviors.

  • b p24 antigen or HIV RNA assay. The p24 antigen is less sensitive but more specific than HIV RNA tests; HIV RNA tests are generally preferred. HIV RNA tests include quantitative branched DNA (bDNA) or reverse-transcriptase polymerase chain reaction (RT-PCR) or qualitative transcription-mediated amplification (APTIMA [GenProbe, San Diego, CA]).

  • Data source: modified from Panel on Antiretroviral Guidelines for Adults and Adolescents. Department of Health and Human Services. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Available at: