Difficulties in diagnosing atypical primary HIV-1 infection

Abstract

Several cases of primary HIV-1 infection are not identified, either because the diagnosis is not suspected or because they test negative for HIV-1 antibody. This work presents an uncommon case of primary HIV-1 infection in an young parenteral drug abuser man, who presented symptoms of acute hepatitis. During the initial acute phase the serum sample of the patient tested negative for the presence of antibodies against several viruses, including HIV-1. Nevertheless, the diagnosis of primary HIV-1 infection was suspected by using an alternative method for"in vitro" induced antibody production (IVIAP), and confirmed by p24 antigen serum positivity and seroconversion in serial plasma samples of the patient. The authors suggest the use of the IVIAP and others complementary assays to help the diagnosis of acute HIV-1 infection in persons at high risk conditions.

Hepatitis as the Presenting Feature of an HIV Seroconversion Illness

“…Abnormal hepatic enzyme levels are seen in up to 21% of seroconversion illnesses 1,2 , but are usually subclinical and rarely presenting features 6 . Co-infection with other hepato-trophic viruses, especially hepatitis B and C virus, is common and may cause hepatitis 7 .…”