A patient exposed to HIV-1 the first time may develop a transient viral syndrome or be asymptomatic. Recognition is important for contact tracing and for educating the patient to prevent spread to others.
Clinical findings in patients with a viral syndrome - some or all of the following:
(1) fever
(2) myalgia
(3) rash
(4) night sweats
(5) arthralgias
(6) malaise
(7) headache
(8) lymphadenopathy
Laboratory findings:
(1) seroconversion in HIV antibody test (recent negative result now positive)
(1) elevated HIV RNA assay
(2) transient drop in CD4 cell count
False positive results occur with both antibody and RNA assays, so diagnosis should not be made based on a single test result alone. Positive antibody test results should be confirmed by Western blot analysis. False positive RNA assays usually report < 10,000 copies per mL, while most true positive values during primary infection are > 100,000 per mL.
A false negative HIV antibody test may occur at seroconversion. A negative result in a high risk patient should be repeated in a few weeks.
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