A 34 year old male presents to the Emergency Department with general feeling of malaise, fatigue, and headaches for one week. The patient denies pharyngitis or cough. The patient denies any past medical or surgical history. Vitals signs are: BP 120/87, HR 102, RR 14, T 101.2F (38.4C). Social history is significant for unprotected sex with multiple male and female partners. Which of the following is TRUE regarding this patient’s likely underlying disease process?
A. Viral antibody test will likely be negative
B. Seroconversion is complete by 4 weeks
C. Serum viral load will likely be negative
D. Viral transmission to other patients begins after patient’s seroconversion phase
A) Viral antibody test will likely be negative is correct
A. Correct: Viral antibody test will likely be negative
The patient has an acute HIV infection, which is characterized by fever, fatigue, headache, and occasionally a rash. It is often confused for influenza viral infection given its nonspecific symptom constellation. He has a significant risk factor for HIV infection and should be tested, although during the acute HIV infection (first 2-3 months) the HIV antibody test may be negative. However, the serum HIV viral load is often detectable and can be quite high.
B. Incorrect: Seroconversion is complete by 4 weeks
In acute HIV infection, seroconversion is generally complete by 10-24 weeks – that is, initial host immune response to HIV is complete, signaled by the serum HIV antibody test first becoming positive in the patient. Because of this delay in completion of seroconversion, there has been an epidemiologic challenge in controlling the HIV pandemic.
C. Incorrect: Serum viral load will likely be negative
In acute HIV infection, serum HIV viral loads can generally start being detected via polymerase chain reaction (PCR) techniques by day 7-8 post-exposure to infection.
D. Incorrect: Viral transmission to other patients begins after patient’s seroconversion phase
This patient is presenting with an acute HIV infection. Technically, acutely infected HIV patients can transmit/infect HIV to another person at any time during the patient’s acute HIV infection, although the patient is highly infectious during the 3rd-4th week of acute HIV infection, when genital shedding of HIV virus peaks. Because patients can be asymptomatic by week 3-4 of their acute HIV infection, they can unknowingly infect others, making eradication of HIV difficult.
