DR.S. MANSORI INFECTIOUS DISEASE SPECIALIST QAZVIN UNIVERCITY OF MEDICAL SCIENCE

 The initial manifestation of HIV infection in one half to two thirds of recently infected individuals  a mononucleosis-like illness

 first described in 1985 by Cooper and colleagues  an acute mononucleosis-like syndrome in 11 of 12 homosexual men who seroconverted for HIV anti-bodies.

 The incidence of the acute retroviral syndrome is not precisely known.  It was reported in 40% to 90% in one study  In one study of 378 persons with acute retroviral syndrome, injection drug users had or reported symptoms less frequently than persons who acquired HIV through sexual transmission.

 The clinical features of the acute retroviral syndrome are nonspecific and variable  The onset of the illness ranges from 1 to 6 weeks aftAer exposure to the virus but peaks at 3 weeks

Fever, sweats, malaise, myalgias, anorexia, nausea, diarrhea, and a nonexudative pharyngitis are prominent symptoms.

 Bilateral facial nerve palsy  Appendicitis

 Two thirds of patients may have a truncal exanthem that may be maculopapular, roseola-like, or urticarial.  Findings of skin biopsies are nonspecific, with perivascular lymphocytic infiltrates and dermal mononuclear cell infiltrates

In addition to aseptic meningitis, neurologic symptoms occur in a minority of patients and may include encephalitis, peripheral neuropathy, and an acute ascending polyneuropathy (Guillain-Barré syndrome)

In patients with neurologic symptoms, the cerebrospinal fluid may show a lymphocytic pleocytosis with normal levels of protein and glucose.

 cervical, occipital, or axillary lymphadenopathy rash, and, less commonly, hepatosplenomegaly.  Oral aphthous ulcerations  Oral and esophageal candidiasis during the seroconversion illness has been reported.  Symptoms generally resolve in 10 to 15 days.

 P.jirovecii pneumonia, cryptococcal meningitis, and Candida esophagitis have been reported in several cases.  Their occurrence is probably caused by the depression of the CD4+ cell count that generally accompanies acute HIV infection.

 reduced total lymphocyte count  elevated sedimentation rate  negative heterophil antibody test  elevated aminotransferase and alkaline phosphatase levels.

 Initially, the total lymphocyte count, including both CD4+ and CD8+ T lymphocytes decreases, with a normal ratio of CD4+ to CD8+ cells.  Within several weeks, both the CD4+ and CD8+ cell populations begin to increase. The rise in CD8+ cell numbers is relatively greater than that in CD4+

 The ratio of CD4+ to CD8+ cells usually remains inverted as the acute illness resolves, primarily because of excess numbers of CD8+ cells.

 antibody reactivity on enzyme immunoassay testing is not found until 14 to 21 days.  plasma HIV RNA, becomes positive at about 5 days after infection  HIV p24 antigen may be detected after 10 days,

 HIV p24 antigen may be detected in the serum and cerebro-spinal fluid in about 75% of patients with primary HIV infection within 2 weeks of exposure, often coincidentally with the onset of symptoms.

 The most sensitive marker for acute HIV infection, however, is plasma HIV RNA, which is markedly elevated in most patients.  false-positive HIV RNA tests may occur, but high-level viremia is diagnostic of acute infection in the absence of anti-HIV antibodies

 infectious mononucleosis  influenza,  viral hepatitis,  measles  rubella  primary herpes simplex virus (HSV) infection,  cytomegalovirus  secondary syphilis.

 careful history to elicit risks for HIV infection  laboratory tests

 lower the viral setpoint,  lead to enhanced CD4+ and CD8+ HIV specific responses,  and decrease the severity of acute disease. BUT  may not provide any long-term benefit.  potential toxicity of long-term therapy  the risk for developing drug resistance

 ART is recommended for persons with early HIV infection—the acute phase of infection up to 6 months after infection.