Early HIV infection

Early HIV infection

Updated: 08/12/2025

© Jun Wang, MD, PhD

 

General features

  • AKA as acute, recent, or primary HIV infection
  • Approximately last 6 months since HIV acquisition

Clinical presentations

  • Up to 60% might be asymptomatic
  • Symptoms usually develop in 2-4 weeks
  • Acute retroviral syndrome: fever, lymphadenopathy, sore throat, rash, myalgia/arthralgia, diarrhea, weight loss, and headache
  • Opportunistic infections may occur with CD4 lymphocytopenia

Key laboratory findings

  • Rapid viral replication results in high viral load
  • Transient CD4 lymphocytopenia and CD8 lymphocytosis
  • CD4 cell count rebound and CD8 cell decreased after peak of viremia
  • Reversed CD4/CD8 ratio
  • Atypical lymphocytes may present
  • Abnormal liver function, thrombocytopenia and anemia might occur

Pathological features

Diagnosis

  • Clinical suspicion: symptoms, history of high risk behaviors
  • Detection of HIV antigen, anti-HIV antibodies and/or HIV viremia

o   Negative for HIV antigen/antibodies, negative HIV viremia: infection unlikely

o   Negative for HIV antigen/antibodies, positive HIV viremia: Likely early infection

o   Positive HIV antigen/antibodies, positive HIV viremia: HIV infection, early or established

Managements

  • Anti-retroviral treatment for all patients
  • Monitoring viral RNA levels

 

 

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Contents

Pathology notes Jun Wang, MD, PhD 1. General information Frequently discussed syndromes Terms of dermatology Terms of hematology 2. Immunodeficiency disorders HIV infection   Primary immunodeficiency disorders 3. Hemodynamic abnormalities Shock Thrombosis and embolism Bleeding disorders Blood transfusion 4.  Benign blood cell disorders Anemia Benign white cell disorders 5. Hematopoietic neoplasms Lymphoid neoplasms Myeloid neoplasms Histiocytic neoplasms: Langerhans cell histiocytosis 6. Cardiovascular system Pulmonary hypertension Cardiovascular system tumors 7. Respiratory tract tumors 8. Gastrointestinal tract Congenital disorders Infectious gastroenteritis Oral cavity Esophagus Stomach Intestinal tumors Salivary glands Exocrine pancreas and gallbladder 9. Urinary system Kidney masses Lower urinary tract 10. Male reproductive system 11. Female genital tract 12. Breast 13. Endocrine organs Pituitary gland Ad...
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Anemia

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Bleeding disorders

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