Acute human immunodeficiency virus type 1 (HIV-1) infectionis a transient symptomatic illness associated with high-titerHIV-1 replication and a robust and expansive immunologic responseto the invading pathogen. From 40 to 90 percent of new HIV-1infections are associated with symptomatic illness. This syndromeis often undiagnosed or misdiagnosed, since HIV-1 antibodiesare usually not detected during the early phase of infection.The diagnosis of acute HIV-1 infection requires a high indexof clinical suspicion and correct use of specific diagnosticlaboratory tests. Accurate early diagnosis is now particularlyimportant because of the potential clinical benefit of earlyantiretroviral . . . [Full Text of this Article]
Pathogenesis
Signs and Symptoms
Diagnosis
Treatment
Conclusions
Source Information
From the AIDS Program, San Francisco General Hospital and the University of California, San Francisco (J.O.K.), and Partners AIDS Research Center, Massachusetts General Hospital and Harvard Medical School, Boston (B.D.W.).
Address reprint requests to Dr. Walker at the Partners AIDS Research Center, Massachusetts General Hospital, 149 13th St., Charlestown, MA 02129.
References
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Del Borgo, C., Soscia, F., Mastroianni, C. M., Leiner, S., Bell, S. K., Gandhi, R. T.
(2009). Case 11-2009: A Man with Fever, Headache, Rash, and Vomiting. NEJM
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[Full Text]
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(2009). Case 11-2009 -- A 47-Year-Old Man with Fever, Headache, Rash, and Vomiting. NEJM
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[Abstract][Full Text]
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Meier, A., Alter, G., Frahm, N., Sidhu, H., Li, B., Bagchi, A., Teigen, N., Streeck, H., Stellbrink, H.-J., Hellman, J., van Lunzen, J., Altfeld, M.
(2007). MyD88-Dependent Immune Activation Mediated by Human Immunodeficiency Virus Type 1-Encoded Toll-Like Receptor Ligands. J. Virol.
81: 8180-8191
[Abstract][Full Text]
Streeck, H., Lichterfeld, M., Alter, G., Meier, A., Teigen, N., Yassine-Diab, B., Sidhu, H. K., Little, S., Kelleher, A., Routy, J.-P., Rosenberg, E. S., Sekaly, R.-P., Walker, B. D., Altfeld, M.
(2007). Recognition of a Defined Region within p24 Gag by CD8+ T Cells during Primary Human Immunodeficiency Virus Type 1 Infection in Individuals Expressing Protective HLA Class I Alleles. J. Virol.
81: 7725-7731
[Abstract][Full Text]
Cantey, J. B., Goldblatt, M., Johnson, G. M., Roberts, J. R.
(2007). A Flu-Like Illness. CLIN PEDIATR
46: 560-562
Lichterfeld, M., Yu, X. G., Mui, S. K., Williams, K. L., Trocha, A., Brockman, M. A., Allgaier, R. L., Waring, M. T., Koibuchi, T., Johnston, M. N., Cohen, D., Allen, T. M., Rosenberg, E. S., Walker, B. D., Altfeld, M.
(2007). Selective Depletion of High-Avidity Human Immunodeficiency Virus Type 1 (HIV-1)-Specific CD8+ T Cells after Early HIV-1 Infection. J. Virol.
81: 4199-4214
[Abstract][Full Text]
Umgelter, A, Huber, W, Schmid, R M, Reindl, W
(2007). Coma as a presenting symptom of primary HIV infection. Sex. Transm. Infect.
83: 85-86
[Abstract][Full Text]
(2007). Missed Opportunities for Earlier Diagnosis of HIV Infection--South Carolina, 1997-2005. JAMA
297: 149-150
[Full Text]
Scadden, D. T., Muse, V. V., Hasserjian, R. P.
(2006). Case records of the Massachusetts General Hospital. Case 30-2006. A 41-year-old man with dyspnea, fever, and lymphadenopathy.. NEJM
355: 1358-1368
[Full Text]
Grant, A. M., Jamieson, D. J., Elam-Evans, L. D., Beck-Sague, C., Duerr, A., Henderson, S. L.
(2006). Reasons for Testing and Clinical and Demographic Profile of Adolescents With Non-Perinatally Acquired HIV Infection. Pediatrics
117: e468-e475
[Abstract][Full Text]
Omrani, A. S., Freedman, A.
(2005). Prophylaxis of HIV infection. Br Med Bull
73-74: 93-105
[Abstract][Full Text]
Coco, A.
(2005). The Cost-Effectiveness of Expanded Testing for Primary HIV Infection. Ann Fam Med
3: 391-399
[Abstract][Full Text]
Coco, A., Kleinhans, E.
(2005). Prevalence of Primary HIV Infection in Symptomatic Ambulatory Patients. Ann Fam Med
3: 400-404
[Abstract][Full Text]
Pao, D, McElborough, D, Fisher, M
(2005). Primary HIV infection masquerading as Munchausen's syndrome. Sex. Transm. Infect.
81: 359-360
[Full Text]
Fernandez, F.
(2005). Ten Myths About HIV Infection and Aids. Focus
3: 184-193
[Full Text]
Peacock, J. W., Nordone, S. K., Jackson, S. S., Liao, H.-X., Letvin, N. L., Yafal, A. G., Gritz, L., Mazzara, G. P., Haynes, B. F., Staats, H. F.
(2004). Gender Differences in Human Immunodeficiency Virus Type 1-Specific CD8 Responses in the Reproductive Tract and Colon following Nasal Peptide Priming and Modified Vaccinia Virus Ankara Boosting. J. Virol.
78: 13163-13172
[Abstract][Full Text]
de Repentigny, L., Lewandowski, D., Jolicoeur, P.
(2004). Immunopathogenesis of Oropharyngeal Candidiasis in Human Immunodeficiency Virus Infection. Clin. Microbiol. Rev.
17: 729-759
[Abstract][Full Text]
Lichterfeld, M., Kaufmann, D. E., Yu, X. G., Mui, S. K., Addo, M. M., Johnston, M. N., Cohen, D., Robbins, G. K., Pae, E., Alter, G., Wurcel, A., Stone, D., Rosenberg, E. S., Walker, B. D., Altfeld, M.
(2004). Loss of HIV-1-specific CD8+ T Cell Proliferation after Acute HIV-1 Infection and Restoration by Vaccine-induced HIV-1-specific CD4+ T Cells. JEM
200: 701-712
[Abstract][Full Text]
Kawamura, T., Bruce, S. E., Abraha, A., Sugaya, M., Hartley, O., Offord, R. E., Arts, E. J., Zimmerman, P. A., Blauvelt, A.
(2004). PSC-RANTES Blocks R5 Human Immunodeficiency Virus Infection of Langerhans Cells Isolated from Individuals with a Variety of CCR5 Diplotypes. J. Virol.
78: 7602-7609
[Abstract][Full Text]
Regoes, R. R., Antia, R., Garber, D. A., Silvestri, G., Feinberg, M. B., Staprans, S. I.
(2004). Roles of Target Cells and Virus-Specific Cellular Immunity in Primary Simian Immunodeficiency Virus Infection. J. Virol.
78: 4866-4875
[Abstract][Full Text]
Kan-Mitchell, J., Bisikirska, B., Wong-Staal, F., Schaubert, K. L., Bajcz, M., Bereta, M.
(2004). The HIV-1 HLA-A2-SLYNTVATL Is a Help-Independent CTL Epitope. J. Immunol.
172: 5249-5261
[Abstract][Full Text]
Fumero, E., Garcia, F., Gatell, J. M.
(2004). Immunosuppressive drugs as an adjuvant to HIV treatment. J Antimicrob Chemother
53: 415-417
[Abstract][Full Text]
Ponz de Leon, M, Benatti, P, Borghi, F, Pedroni, M, Scarselli, A, Di Gregorio, C, Losi, L, Viel, A, Genuardi, M, Abbati, G, Rossi, G, Menigatti, M, Lamberti, I, Ponti, G, Roncucci, L
(2004). Aetiology of colorectal cancer and relevance of monogenic inheritance. Gut
53: 115-122
[Abstract][Full Text]
Aggarwal, M., Rein, J.
(2003). Acute Human Immunodeficiency Virus Syndrome in an Adolescent. Pediatrics
112: e323-323
[Abstract][Full Text]
Alter, G., Hatzakis, G., Tsoukas, C. M., Pelley, K., Rouleau, D., LeBlanc, R., Baril, J.-G., Dion, H., Lefebvre, E., Thomas, R., Cote, P., Lapointe, N., Routy, J.-P., Sekaly, R.-P., Conway, B., Bernard, N. F.
(2003). Longitudinal Assessment of Changes in HIV-Specific Effector Activity in HIV-Infected Patients Starting Highly Active Antiretroviral Therapy in Primary Infection. J. Immunol.
171: 477-488
[Abstract][Full Text]
Biviji, A. A., Paiement, G. D., Steinbach, L. S.
(2002). Musculoskeletal Manifestations of Human Immunodeficiency Virus Infection. J Am Acad Orthop Surg
10: 312-320
[Abstract][Full Text]
Harari, A., Rizzardi, G. P., Ellefsen, K., Ciuffreda, D., Champagne, P., Bart, P.-A., Kaufmann, D., Telenti, A., Sahli, R., Tambussi, G., Kaiser, L., Lazzarin, A., Perrin, L., Pantaleo, G.
(2002). Analysis of HIV-1- and CMV-specific memory CD4 T-cell responses during primary and chronic infection. Blood
100: 1381-1387
[Abstract][Full Text]
Kang, E. M., de Witte, M., Malech, H., Morgan, R. A., Phang, S., Carter, C., Leitman, S. F., Childs, R., Barrett, A. J., Little, R., Tisdale, J. F.
(2002). Nonmyeloablative conditioning followed by transplantation of genetically modified HLA-matched peripheral blood progenitor cells for hematologic malignancies in patients with acquired immunodeficiency syndrome. Blood
99: 698-701
[Abstract][Full Text]
von Reyn, C. F., Mark, E. J.
(2001). Case 33-2001- A 33-Year-Old Man with a Rash, Pulmonary Infection, and Neurologic Disorder. NEJM
345: 1263-1269
[Full Text]
Hansasuta, P., Rowland-Jones, S. L
(2001). HIV-1 transmission and acute HIV-1 infection. Br Med Bull
58: 109-127
[Abstract][Full Text]
Bouhlal, H., Hocini, H., Quillent-Gregoire, C., Donkova, V., Rose, S., Amara, A., Longhi, R., Haeffner-Cavaillon, N., Beretta, A., Kaveri, S. V., Kazatchkine, M. D.
(2001). Antibodies to C-C Chemokine Receptor 5 in Normal Human IgG Block Infection of Macrophages and Lymphocytes with Primary R5-Tropic Strains of HIV-1. J. Immunol.
166: 7606-7611
[Abstract][Full Text]
Baldrich-Rubio, E., Anagonou, S., Stirrups, K., Lafia, E., Candotti, D., Lee, H., Allain, J. P.
(2001). A complex human immunodeficiency virus type 1 A/G/J recombinant virus isolated from a seronegative patient with AIDS from Benin, West Africa. J. Gen. Virol.
82: 1095-1106
[Abstract][Full Text]
Hogan, C. M., Hammer, S. M.
(2001). Host Determinants in HIV Infection and Disease: Part 1: Cellular and Humoral Immune Responses. ANN INTERN MED
134: 761-776
[Abstract][Full Text]
Altfeld, M. A., Livingston, B., Reshamwala, N., Nguyen, P. T., Addo, M. M., Shea, A., Newman, M., Fikes, J., Sidney, J., Wentworth, P., Chesnut, R., Eldridge, R. L., Rosenberg, E. S., Robbins, G. K., Brander, C., Sax, P. E., Boswell, S., Flynn, T., Buchbinder, S., Goulder, P. J. R., Walker, B. D., Sette, A., Kalams, S. A.
(2001). Identification of Novel HLA-A2-Restricted Human Immunodeficiency Virus Type 1-Specific Cytotoxic T-Lymphocyte Epitopes Predicted by the HLA-A2 Supertype Peptide-Binding Motif. J. Virol.
75: 1301-1311
[Abstract][Full Text]
Bisno, A. L.
(2001). Acute Pharyngitis. NEJM
344: 205-211
[Full Text]
Daar, E. S., Little, S., Pitt, J., Santangelo, J., Ho, P., Harawa, N., Kerndt, P., Giorgi, J. V., Bai, J., Gaut, P., Richman, D. D., Mandel, S., Nichols, S., for the Los Angeles County Primary HIV Infection R,
(2001). Diagnosis of Primary HIV-1 Infection. ANN INTERN MED
134: 25-29
[Abstract][Full Text]
Flanigan, T., Tashima, K. T.
(2001). Diagnosis of Acute HIV Infection: It's Time To Get Moving!. ANN INTERN MED
134: 75-77
[Full Text]
(2001). Before Seroconversion: The Clinical and Scientific Events of Acute HIV Infection and the Immunologic Benefits of Treatment. AIDS Clin Care
2001: 7-7
[Full Text]
Kawamura, T., Cohen, S. S., Borris, D. L., Aquilino, E. A., Glushakova, S., Margolis, L. B., Orenstein, J. M., Offord, R. E., Neurath, A. R., Blauvelt, A.
(2000). Candidate Microbicides Block HIV-1 Infection of Human Immature Langerhans Cells within Epithelial Tissue Explants. JEM
192: 1491-1500
[Abstract][Full Text]
Friedman, S. R., Kottiri, B. J., Neaigus, A., Curtis, R., Vermund, S. H., Des Jarlais, D. C.
(2000). Network-related Mechanisms May Help Explain Long-term HIV-1 Seroprevalence Levels That Remain High but Do Not Approach Population-Group Saturation. Am J Epidemiol
152: 913-922
[Abstract][Full Text]
Colven, R., Harrington, R. D., Spach, D. H., Cohen, C. J., Hooton, T. M.
(2000). Retroviral Rebound Syndrome after Cessation of Suppressive Antiretroviral Therapy in Three Patients with Chronic HIV Infection. ANN INTERN MED
133: 430-434
[Abstract][Full Text]
Szabo, R., Short, R. V
(2000). How does male circumcision protect against HIV infection?. BMJ
320: 1592-1594
[Full Text]
Cabre, P, Smadja, D, Cabié, A, Newton, C R J C
(2000). NEUROLOGICAL ASPECTS OF TROPICAL DISEASE: HTLV-1 and HIV infections of the central nervous system in tropical areas. J. Neurol. Neurosurg. Psychiatry
68: 550-557
[Full Text]
Van Rompay, K. K. A., Miller, M. D., Marthas, M. L., Margot, N. A., Dailey, P. J., Canfield, D. R., Tarara, R. P., Cherrington, J. M., Aguirre, N. L., Bischofberger, N., Pedersen, N. C.
(2000). Prophylactic and Therapeutic Benefits of Short-Term 9-[2-(R)-(Phosphonomethoxy)Propyl]Adenine (PMPA) Administration to Newborn Macaques following Oral Inoculation with Simian Immunodeficiency Virus with Reduced Susceptibility to PMPA. J. Virol.
74: 1767-1774
[Abstract][Full Text]
Zhang, Z., Schuler, T., Zupancic, M., Wietgrefe, S., Staskus, K. A., Reimann, K. A., Reinhart, T. A., Rogan, M., Cavert, W., Miller, C. J., Veazey, R. S., Notermans, D., Little, S., Danner, S. A., Richman, D. D., Havlir, D., Wong, J., Jordan, H. L., Schacker, T. W., Racz, P., Tenner-Racz, K., Letvin, N. L., Wolinsky, S., Haase, A. T.
(1999). Sexual Transmission and Propagation of SIV and HIV in Resting and Activated CD4+ T Cells. Science
286: 1353-1357
[Abstract][Full Text]
M. McKinney, D., Lewinsohn, D. A., Riddell, S. R., Greenberg, P. D., Mosier, D. E.
(1999). The Antiviral Activity of HIV-Specific CD8+ CTL Clones Is Limited by Elimination Due to Encounter with HIV-Infected Targets. J. Immunol.
163: 861-867
[Abstract][Full Text]
Canque, B., Bakri, Y., Camus, S., Yagello, M., Benjouad, A., Gluckman, J. C.
(1999). The Susceptibility to X4 and R5 Human Immunodeficiency Virus-1 Strains of Dendritic Cells Derived In Vitro From CD34+ Hematopoietic Progenitor Cells Is Primarily Determined by Their Maturation Stage. Blood
93: 3866-3875
[Abstract][Full Text]
Rich, J. D., Merriman, N. A., Mylonakis, E., Greenough, T. C., Flanigan, T. P., Mady, B. J., Carpenter, C. C.J.
(1999). Misdiagnosis of HIV Infection by HIV-1 Plasma Viral Load Testing: A Case Series. ANN INTERN MED
130: 37-39
[Abstract][Full Text]
Hecht, F. M., Grant, R. M., Petropoulos, C. J., Dillon, B., Chesney, M. A., Tian, H., Hellmann, N. S., Bandrapalli, N. I., Digilio, L., Branson, B., Kahn, J. O.
(1998). Sexual Transmission of an HIV-1 Variant Resistant to Multiple Reverse-Transcriptase and Protease Inhibitors. NEJM
339: 307-311
[Full Text]
Stranford, S. A., Ong, J. C., Martinez-Marino, B., Busch, M., Hecht, F. M., Kahn, J., Levy, J. A.
(2001). Reduction in CD8+ cell noncytotoxic anti-HIV activity in individuals receiving highly active antiretroviral therapy during primary infection. Proc. Natl. Acad. Sci. USA
98: 597-602
[Abstract][Full Text]