Acute infection with HIV 1

Abstract

The diagnosis of acute human immunodefi ciency virus (HIV)
syndrome requires a high index of suspicion and specifi c laboratory testing. Symptoms associated with HIV infection are
common among seroconverts, but their non-specifi c nature and
the absence of a universally accepted defi nition, makes this a
major diagnostic challenge to health care providers. The authors
present a case of a 32-year-old man, previously asymptomatic,
admitted to our institution because of a mononucleosis-like
illness associated with diarrhoea, anorexia, fatigue and weight
loss. The physical examination revealed fever, exsudative tonsillitis and pharyngitis, lymphadenopathy and liver enlargement.
Laboratory studies indicated anaemia, lymphocytosis with atypical
lymphocytes, high liver enzymes and LDH. He denied risk factors
for HIV infection and had negative HIV serology 4 months prior
to admission (blood donor testing). Despite the serology for EBV
being positive, other serologies were asked for, including ELISA
for HIV, that confi rmed seroconversion. Colonoscopy and biopsies
revealed an unspecifi c infl ammatory colitis, compatible with HIV
colitis. Antiretroviral therapy was started and after 4 weeks the
patient became asymptomatic, showing an increase in CD4+ cell
count and lower viral load.
This case illustrates that even in patients without clear risk
factors for HIV infection, acute retroviral syndrome should be
considered in the differential diagnosis of mononucleosis like
syndrome. Also a positive serology for EBV doesn’t exclude HIV
infection, and the suspicion of acute HIV illness should prompt
virology analysis. Recognition of acute retroviral syndrome helps
us to limit transmission and probably to improve the prognosis of
these patients with the possibility of early treatment.