Diagnosis of Primary HIV-1 Infection

  title={Diagnosis of Primary HIV-1 Infection},
  author={Eric S Daar and Susan J Little and J Pitt and J Santangelo and Pauline Ho and Nina T. Harawa and Peter R. Kerndt and Janis V. Giorgi and Jie Bai and Paula Gaut and Douglas D. Richman and Susan J. Mandel and S Nichols},
  journal={Annals of Internal Medicine},
Primary HIV infection is characterized by diverse clinical symptoms (1, 2). Since patients with primary infection are just developing HIV antibodies, recognition of the syndrome in at-risk persons should prompt antibody testing as well as a virologic assay (3, 4). Diagnosing primary infection may decrease HIV transmission (5) and allow consideration of early treatment (2, 6). To date, the optimal patients to screen and the best algorithm for use of diagnostic tests have not been determined. The… 
Clinical presentation and diagnosis of primary HIV-1 infection
More numerous and severe primary HIV-1 infection symptoms predict more rapid disease progression, and further research is needed to define optimal strategies for increasing detection of primary HIV/1 infection.
Diagnosing Primary HIV Infection
The statement that clinicians may be confident that more than 90% of patients with primary HIV infection will be identified by a standard HIV p24 antigen test alone is potentially misleading for several reasons.
Use of laboratory tests and clinical symptoms for identification of primary HIV infection
Rash and fever indicated the highest risk of primary HIV infection (PHI), and HIV-1 RNA tests are very sensitive for PHI but false-positive results occur.
The Cost-Effectiveness of Expanded Testing for Primary HIV Infection
  • A. Coco
  • Medicine, Biology
    The Annals of Family Medicine
  • 2005
Expanded testing for primary HIV infection with p24 antigen EIA with a 67% probability of being cost-effective at the baseline prevalence and a 71% probability at a prevalence of 1% may be a sound expenditure of health care resources.
Risk-Based Human Immunodeficiency Virus (HIV) Testing Fails to Detect the Majority of HIV-Infected Persons in Medical Care Settings
Although one-third of newly diagnosed HIV-infected patients had clinical visits in the 3 years before diagnosis, few presented with clinical conditions typically associated with HIV infection, and targeted testing based on clinical presentations is not likely to result in substantially earlier HIV diagnosis.
Missed opportunities for diagnosing primary HIV infection
Individuals in high-risk groups need to be informed to access healthcare when they experience symptoms of seroconversion and non-HIV/GUM healthcare providers may benefit from training in case recognition to improve rates of diagnosis.
Prevalence of Primary HIV Infection in Symptomatic Ambulatory Patients
Estimates of the prevalence of primary HIV infection in symptomatic ambulatory patients with fever, rash, and pharyngitis can aid with development of clinical testing guidelines and clinical decisions around testing for acute HIV infection.
Prevalence and Correlates of Unknown HIV Infection among Patients Seeking Care in a Public Hospital Emergency Department
In a sample of patients visiting a county ED, the relative prevalence of unknown HIV infection was modest and less than national estimates (25%).
Detection of Acute HIV Infection in Two Evaluations of a New HIV Diagnostic Testing Algorithm — United States, 2011–2013
The highly infectious phase of acute human immunodeficiency virus (HIV) infection, defined as the interval between the appearance of HIV RNA in plasma and the detection of HIV-1-specific antibodies,


Clinical and Epidemiologic Features of Primary HIV Infection
The events leading to the acquisition of HIV and the initial clinical and diagnostic evaluation of 46 patients with primary HIV infection are summarized.
Risk factors and clinical presentation of acute primary HIV infection in India.
This systematic case-control study of p24 antigen screening in HIV-seronegative patients attending STD clinics in India identified unprotected sex with a CSW and a genital ulcer as independent risk factors associated with newly acquired HIV infection.
Misdiagnosis of HIV Infection by HIV-1 Plasma Viral Load Testing: A Case Series
Three cases demonstrate the potential problems of using HIV-1 plasma viral load tests for diagnosis of HIV infection and two cases of false-positive results obtained by using branched-chain DNA assay (Chiron Quantiplex, Emeryville, California) are reported.
Detection of infection with human immunodeficiency virus type 1 before seroconversion: correlation with clinical symptoms and outcome.
The decline in CD4 cells was slower and the duration of AIDS-free time longer in the 19 men who were symptomatic in comparison to the 31 asymptomatic men with early infection, but differences were not significant.
Transient high levels of viremia in patients with primary human immunodeficiency virus type 1 infection.
The rapid and spontaneous decline in the viral load suggests an effective immune response in the host that, if understood, may be used to combat AIDS.
Acute human immunodeficiency virus type 1 infection.
The diagnosis of acute HIV-1 infection requires a high index of clinical suspicion and correct use of specific diagnostic laboratory tests and the potential clinical benefit of early antiretroviral treatment.
Acute human immunodeficiency virus type 1 disease as a mononucleosis-like illness: is the diagnosis too restrictive?
  • P. Vanhems, R. Allard, J. Lambert
  • Medicine
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 1997
Clinical features at the time of acute human immunodeficiency virus type 1 (HIV-1) disease in 218 patients with documented symptomatic primary HIV-1 infection were described.
Zidovudine treatment in patients with primary (acute) human immunodeficiency virus type 1 infection: a randomized, double-blind, placebo-controlled trial. DATRI 002 Study Group. Division of AIDS Treatment Research Initiative.
Six months of high-dose zidovudine initiated during PHI results in higher CD4 cell counts and lower PBMC culture titers but no difference in plasma HIV-1 RNA.
Role of the primary infection in epidemics of HIV infection in gay cohorts.
This interpretation of the role of the primary infection is not conclusive, but its implications for prevention and for vaccine trials are so markedly different from those of other interpretations that it is considered to be an important hypothesis for further testing.
Vigorous HIV-1-specific CD4+ T cell responses associated with control of viremia.
In individuals who control viremia in the absence of antiviral therapy, polyclonal, persistent, and vigorous HIV-1-specific CD4+ T cell proliferative responses were present, resulting in the elaboration of interferon-gamma and antiviral beta chemokines.