ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferencesInformation for PatientsView all Images (9)
Human immunodeficiency virus primary infection
Print
Other Resources UpToDate PubMed

Human immunodeficiency virus primary infection

Print Patient Handout Images (9)
Contributors: Mamello Ntsele MBChB, FCDerm, Neil Mendoza MD, Anisa Mosam MBChB, MMed, FCDerm, PhD, Ncoza C. Dlova MBChB, FCDerm, PhD, Paritosh Prasad MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Primary human immunodeficiency virus infection (PHI) syndrome, also called acute retroviral syndrome and seroconversion disease, is an acute mononucleosis-like illness that develops anywhere from 1-6 weeks following exposure to human immunodeficiency virus (HIV). Acute HIV infection, according to the Fiebig classification, is the period between viral acquisition and the emergence of HIV-specific antibodies. This period is associated with a high viral load. Patients with PHI syndrome may be asymptomatic or they can present with a variety of nonspecific symptoms and signs. A high index of suspicion is needed to make the diagnosis.

PHI syndrome is believed to occur in 50%-66% of newly infected individuals. Symptoms are variable; fever, headache, lymphadenopathy, nausea, diarrhea, rash, and pharyngitis are usually present. Other symptoms include vomiting, arthralgias, and photophobia. Rarely, neurological symptoms and hepatosplenomegaly are seen. Symptoms usually resolve within 15 days.

The rash is characteristically a morbilliform truncal exanthem that may resemble an exanthematous drug eruption or a viral exanthem. The palms and soles are usually spared. An enanthem with erythema and oral ulcers may be seen in more than half of patients with the syndrome. Genital ulcers are seen in around one-third.

PHI is important to recognize from a public health perspective. Patients with PHI are 10 times more likely to transmit HIV compared with patients in the chronic phase of HIV infection. Patients with PHI syndrome are most likely to present to primary care physicians, emergency rooms, urgent care and walk-in centers, or general medicine clinics. Approximately 90% of cases are not diagnosed at the primary encounter.

Codes

ICD10CM:
B20 – Human immunodeficiency virus [HIV] disease

SNOMEDCT:
111880001 – Acute HIV infection

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

  • Other causes of fever and lymphadenopathy (Epstein-Barr virus infection, cytomegalovirus infection, toxoplasmosis) – Testing for these pathogens can be performed.
  • Exanthematous drug eruption if there is a history of preceding medication use.
  • Influenza – Lymphadenopathy is not a typical finding and patients have prominent respiratory symptoms.
  • Measles – Conjunctivitis, coryza, and cough are usually seen with measles. Patients also have rash and fever.
  • Rubella – Rash and lymphadenopathy may be present.
  • Secondary syphilis – Patients typically have rash (involvement of the palms and soles is common) and lymphadenopathy.
  • Brucellosis – There is a spectrum of possible symptoms. Patients with acute infection are usually febrile and may have lymphadenopathy. The patient should be questioned regarding possible animal exposure or the consumption of unpasteurized dairy products.
  • Malaria – Patient should have a consistent travel history.

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

References

Subscription Required

Last Reviewed: 01/15/2019
Last Updated: 01/15/2019
Copyright © 2019 VisualDx®. All rights reserved.
Human immunodeficiency virus primary infection
Print 9 Images
View all Images (9)
(with subscription)
Human immunodeficiency virus primary infection : Diarrhea, Fatigue, Fever, Headache, Nausea, Vomiting, Rash, Lymphadenopathy, Widespread, Myalgia, Pharyngitis
Clinical image of Human immunodeficiency virus primary infection
Copyright © 2019 VisualDx®. All rights reserved.