Acute HIV Infection: Symptoms and Diagnosis

Q: Acute HIV Infection: Symptoms and Diagnosis

Dear readers： According to the Centers for Disease Control website (http：//www.cdc.gov.tw), there are three main routes of HIV transmission： 1. <br>Sexual transmission： Engaging in oral, anal, or vaginal intercourse or other exchanges of bodily fluids with an HIV-infected individ

Acute HIV infection phase?

Hello Doctor, I started feeling unwell around August 29, experiencing fever and fatigue.
On August 30, I had blood tests showing a CRP of 7.490 (all other biochemical parameters were normal), WBC of 12,870, Neutrophils 70.8%, Lymphocytes 19.9%, and Monocytes 8.3%.
On September 1, my ESR was 49 mm (1 hr) / 92 mm (2 hr).
The outpatient physician prescribed enteric-coated Salazopyrin and Celebrex for treatment (as I have JRA).
My symptoms continued with a fever around 37.9°C, with recurrent fever and defervescence approximately once a day, with temperatures ranging from 38.0°C to 38.6°C.
On September 3, my blood tests showed a CRP of 21 and WBC of 19,000, with normal urinalysis.
On September 4, my fever peaked at 39.0°C.
On September 5, I was prescribed Inj Methasone 5 mg once daily, Unasyn 1.5 g every 6 hours, and oral Erythromycin 500 mg three times a day.
By September 5, my temperature began to stabilize without further fever.
On September 6, WBC, Monocytes, FDP, Ferritin, and liver function tests were elevated.
As of now, I have no rashes, lymphadenopathy, nausea, vomiting, diarrhea, cough, cold, runny nose, or sore throat symptoms.
There is a suspicion of infiltrate in the lower lobe of the chest, and blood and urine cultures have no reports yet.
JRA-related autoimmune diseases have been temporarily ruled out.
Could you please advise if this situation might indicate acute HIV infection? Thank you for taking the time to read and respond.

Xiao Cheng, 20~29 year old female. Ask Date: 2017/09/06

Dr. Liao Zhongxin reply Internal Medicine

Dear readers: According to the Centers for Disease Control website (http://www.cdc.gov.tw), there are three main routes of HIV transmission: 1.
Sexual transmission: Engaging in oral, anal, or vaginal intercourse or other exchanges of bodily fluids with an HIV-infected individual carries a risk of infection.
2.
Blood transmission: (1) Receiving or coming into contact with blood or blood products contaminated with HIV.
(2) Sharing needles, syringes, or diluents with intravenous drug users who are HIV-positive.
(3) Receiving an organ transplant from an HIV-infected donor.
3.
Vertical transmission from mother to child: An infant can acquire HIV from an infected mother during pregnancy, childbirth, or breastfeeding.
If none of these high-risk behaviors are present, the likelihood of contracting HIV is low.
Thank you!

Reply Date: 2017/09/06

More Info

Acute HIV infection, also known as primary HIV infection, typically occurs within 2 to 4 weeks after exposure to the virus. During this period, individuals may experience a range of symptoms that can resemble those of a flu or other viral infections. Common symptoms include fever, fatigue, sore throat, swollen lymph nodes, and muscle aches. However, it is important to note that not everyone will exhibit these symptoms, and some may be mild or go unnoticed.

In your case, the timeline of your symptoms starting around August 29, along with the laboratory findings, raises some concerns. The elevated CRP and WBC counts suggest an inflammatory response, which could be due to an infection. The fluctuating fever and other systemic symptoms you described could potentially align with acute HIV infection, but they are also consistent with a variety of other infections or conditions.

The absence of specific symptoms such as rash, lymphadenopathy, or gastrointestinal symptoms (nausea, vomiting, diarrhea) does not rule out HIV infection, as individuals can present differently. The fact that you have not experienced any respiratory symptoms like cough or sore throat until later could also indicate that your body is responding to an infection, but it does not specifically point to HIV.

Regarding the laboratory tests, the elevated CRP and WBC levels indicate an inflammatory process, while the ESR (erythrocyte sedimentation rate) is also elevated, suggesting ongoing inflammation. However, these findings are nonspecific and can occur in various infections, including viral, bacterial, or even autoimmune conditions.

To determine whether you are in the acute phase of HIV infection, it is crucial to undergo specific HIV testing. The standard tests include the HIV antibody test and the HIV antigen/antibody combination test (often referred to as a "4th generation" test). The antigen test can detect the p24 antigen, which appears in the blood shortly after infection, typically within 1 to 2 weeks. If you suspect recent exposure, it is advisable to get tested as soon as possible, and if the initial test is negative, follow-up testing is recommended after 3 months to rule out infection due to the window period.

In conclusion, while your symptoms and lab findings could suggest a viral infection, they are not definitive for acute HIV infection. It is essential to consult with a healthcare provider for appropriate testing and evaluation. Early diagnosis and treatment are crucial in managing HIV effectively, and understanding your status can help you make informed decisions about your health and any necessary precautions to prevent transmission. If you have engaged in high-risk behaviors, it is particularly important to seek testing and counseling.

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