Acute Retroviral Syndrome

From Anvita Health Wiki

Contents 1 Clinical-manifestations 2 Laboratory 3 Differential-diagnosis 4 Management 5 More General Terms 6 Additional Terms 7 References

Clinical-manifestations

• flu-like or mononucleosis-like illness & exanthem in 40-90% of patients with acute HIV infection

• arthralgias & arthritis
• myalgias & myositis
• headache
• lymphadenopathy
• exudative pharyngitis
• hepatosplenomegaly
• meningitis & encephalitis
• vasculitis
• rash (exanthum)
• cough
• fever
• diarrhea
• nausea/vomiting
• weight loss
• other neurologic manifestations

• peripheral neuropathy
• facial palsy
• Guillain-Barre syndrome
• brachial neuritis
• cognitive impairment
• psychosis

• time course of symptoms

• generally occurs from 2-6 weeks after exposure
• occurs 10-21 days before seroconversion
• generally resolve without therapy in 7-10 days

• a longer duration of symptoms associated with seroconversion generally results in a more rapid progression to AIDS
• exanthem may be morbilliform or pityriasis rosea-like, most prominent on the trunk & face
• the exanthem is self-limited & often goes undiagnosed
• oral ulceration ( aphthous stomatitis), oropharyngeal candidiasis or erosive esophagitis may occur
• reactivation of orolabial Herpes simplex

Laboratory

• quantitative HIV1 RNA levels

• high levels of HIV1 RNA (500,000- 21 million copies/ mL) are detected in plasma before the detection of specific HIV1 antibodies
• the high level of viremia decreases 100-10,000 fold coincident with development of the specific anti-HIV1 humoral immune response - cytotoxic T-cells may be responsible for this decline in HIV1 viral load

• specific HIV1 antibodies* are not detectable until 4-12 weeks after initial infection

• HIV1 ELISA for antibody to HIV1 is negative
• confirmatory HIV1 Western blot is negative

Differential-diagnosis

• infectious mononucleosis

Management

• early highly-active antiretroviral therapy ( HAART) may favorably alter the course of infection

More General Terms

• syndrome
• viral infection

Additional Terms

• aphthous stomatitis (canker sore)
• arthralgia
• encephalitis
• esophagitis
• Herpes simplex (HSV) or Herpes hominis
• human immunodeficiency virus-1
• infectious mononucleosis
• lymphadenopathy
• meningitis
• myalgia (muscle pain)
• myositis (inflammatory myopathy)
• oropharyngeal candidiasis (thrush)
• pharyngitis
• vasculitis

References

1. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, American College of Physicians, Philadelphia 1998, 2006, 2009
2. Veterans Administration, Mather, CA

acute retroviral syndrome