Infrequent Diagnosis of Primary Human Immunodeficiency Virus Infection

Weintrob, Amy; Giner, Julieta; Menezes, Prema; Patrick, Ericka; Benjamin, Daniel K.; Lennox, Jeffrey L.; Pilcher, Christopher D.; Eron, Joseph J.; Hicks, Charles B.

doi:10.1001/archinte.163.17.2097

Cited by 93 publications

(56 citation statements)

References 23 publications

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“…31 Symptoms of acute retroviral syndrome are outlined in Table 1. During the acute stages of infection, antibody testing might yield a negative or indeterminate result while RNA testing results are positive.…”

Section: Testing For Hivmentioning

confidence: 99%

Adolescents and HIV Infection: The Pediatrician's Role in Promoting Routine Testing

Emmanuel¹,

Martinez²

2011

Pediatrics

101

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Pediatricians can play a key role in preventing and controlling HIV infection by promoting risk-reduction counseling and offering routine HIV testing to adolescent and young adult patients. Most sexually active youth do not feel that they are at risk of contracting HIV and have never been tested. Obtaining a sexual history and creating an atmosphere that promotes nonjudgmental risk counseling is a key component of the adolescent visit. In light of increasing numbers of people with HIV/AIDS and missed opportunities for HIV testing, the Centers for Disease Control and Prevention recommends universal and routine HIV testing for all patients seen in health care settings who are 13 to 64 years of age. There are advances in diagnostics and treatment that help support this recommendation. This policy statement reviews the epidemiologic data and recommends that routine screening be offered to all adolescents at least once by 16 to 18 years of age in health care settings when the prevalence of HIV in the patient population is more than 0.1%. In areas of lower community HIV prevalence, routine HIV testing is encouraged for all sexually active adolescents and those with other risk factors for HIV. This statement addresses many of the real and perceived barriers that pediatricians face in promoting routine HIV testing for their patients.

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Section: Testing For Hivmentioning

confidence: 99%

Adolescents and HIV Infection: The Pediatrician's Role in Promoting Routine Testing

Emmanuel¹,

Martinez²

2011

Pediatrics

101

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“…Since acute retroviral syndromes mimic many common febrile illnesses, including infectious mononucleosis, influenza, malaria, and rickettsial diseases (1,10), the true diagnosis (acute HIV) is rarely considered at an initial patient encounter (1,(10)(11)(12). The diagnostic challenge in acute HIV infection is made more difficult by the fact that routine HIV antibody tests will typically remain negative for 1-2 weeks beyond the onset of acute retroviral symptoms (26-35 days following initial infection) (5, 13); additional virus-specific diagnostic tests (e.g., HIV p24 antigen ELISA and HIV nucleic acid amplification assays) are needed to detect HIV infection prior to the appearance of antibodies ( Figure 1).…”

mentioning

confidence: 99%

Acute HIV revisited: new opportunities for treatment and prevention

et al. 2004

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“…6 However, due to its protean manifestations, only 17% of symptomatic acute cases are accurately diagnosed. 7 Maintaining high vigilance and aggressive testing for acute HIV (such as testing HIV viral loads), especially in high-risk populations, are essential for limiting the spread of the epidemic. Raising awareness among health care providers about the myriad of possible presentations of acute HIV, including unusual ones like this, will contribute to global efforts to combat this epidemic.…”

Section: Discussionmentioning

confidence: 99%

Acute HIV infection presenting as fulminant meningoencephalitis with massive CSF viral replication

2014

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A 22-year-old man presented to the emergency department with 10 days of malaise, generalized rash, sore throat, oral ulcers, headache, nausea, and vomiting. On examination he had fever (101.5°F), hepatosplenomegaly, generalized maculopapular rash, and lymphadenopathy. He rapidly became obtunded, requiring intubation. Initial laboratory studies showed mild transaminitis, increased lactate dehydrogenase, and 4,600 leukocytes per mL with 61% bands and 18% lymphocytes. Bacterial and fungal blood cultures were negative as well as a rapid HIV test, additional serologies (including rapid plasma reagin and Treponema pallidum particle agglutination), quantitative PCRs (for viruses other than HIV), and urine and blood toxicology. CSF, on hospital day 4, showed a lymphocytic pleocytosis (total leukocytes: 100), high protein, borderline hypoglycorrhachia, and negative Gram stain and culture. Brain MRI revealed no meningeal enhancement or masses. EEG revealed no epileptiform activity. Flow cytometry on bone marrow biopsy and CSF found no evidence of malignancy; neither did an excisional lymph node biopsy ( figure 1). An immunofluorescent assay test for HIV returned inconclusive and a Western blot detected HIV gp120/gp160 bands. Quantitative HIV RNA PCR was 1.4 3 10 6 copies/mL in plasma and in CSF exceeded the upper limit of quantitation (10 7 copies/mL) (figure 2). The patient's clinical status improved and he was discharged 11 days later with a diagnosis of acute HIV infection with meningoencephalitis. Eighteen days after presentation, darunavir, ritonavir, emtricitabine, and tenofovir were started. A month later, low avidity HIV-1 antibodies were detected and neuropsychological testing revealed mild to moderate impairment in information processing speed, verbal fluency, and motor skills. Neurologic examination showed a mild spastic paraparesis with impaired ambulation. A spinal MRI 2 months later was nondiagnostic. Six months after presentation, his gait was improved, but upper neuron signs remained. Virologic suppression in plasma and CSF was achieved 5 months after initiating antiretroviral therapy (ART) (figure 2).

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Infrequent Diagnosis of Primary Human Immunodeficiency Virus Infection

Cited by 93 publications

References 23 publications

Adolescents and HIV Infection: The Pediatrician's Role in Promoting Routine Testing

Adolescents and HIV Infection: The Pediatrician's Role in Promoting Routine Testing

Acute HIV revisited: new opportunities for treatment and prevention

Acute HIV infection presenting as fulminant meningoencephalitis with massive CSF viral replication

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