I am a physician working in Hong Kong and I follow your very valuable
"column" avidly for the insights
it gives me (Info. in HK is rather limited!). I am well aware of the value
these days of being able to
recognise symptomatic primary infection and its implications for treatment
and I wonder if you could
help me on this. I have a patient who had a sexual encounter in Thailand.
38-39 days later he came down
with flu like symptoms (beginning with pharyngitis) and a rash. The rash was
rather similar to a group of
5 or 6 insect bites, the lesions bieng erythmatous and about, say, 3-4 mm in
diameter and slightly raised.
There was no "background" redness. The locarion was at the junction of the
hip with the lower abdomen
and the duration was about 5 days followed by a gradual fading (over the next
5 days). I am aware that
symptomatic seroconversion is not always apparent and that the symptoms may
be variable but would
have the following questions: 1) How does the rash associated with
seroconversion normally present, and
2) what would be a normal time for the onset of symptoms (the literature is,
as usual, very confused on
this one!) By the way, my patient had no lyphodenapathy apart from the usual
soreness at the angle of the
jaw associated with his sore throat! Thanks again for you help!
Hi. Thank you for your questions.
First, let me review with you the symptoms associated with recent HIV
Within the first few weeks after infection (usually within a month or so
post-infection), some people (perhaps up to 70%) with HIV show symptoms due
to "Acute Viral Syndrome". This occurs during your bodies initial response
against the virus. During this time, a person may show symptoms that look
exactly like the flu (headaches, body aches, fevers, fatigue etc). The
symptoms last for a week or two, then go away by themselves. They do NOT
persist for many weeks or months. Some people who acquire HIV may have
severe flu-like symptoms due to Acute Viral Syndrome. In other people with
HIV, these symptoms may be very mild. In still other people with HIV, they
may not show these symptoms at all. A person may, or may not, show positive
on an antibody test during this period of time. I must strongly emphasize
here that the symptoms of Acute Viral Syndrome look exactly like the symptoms
of other illnesses, so having flu symptoms does not indicate HIV infection,
in of itself. It is also important to remember that not all people will get
Acute Viral Syndrome, and in those that do get it, the severity can vary from
person to person.
There can sometimes be a rash associated with Acute Viral Syndrome. It's
generally a maculopapular rash, and is often found on the upper trunk of the
body. Like other symptoms of Acute Viral Syndrome, this rash looks like
other skin conditions, and only lasts for about 1-2 weeks, then goes away by
itself. And I must strongly emphasize that it looks like rashes associated
with other skin conditions, and not all people with Acute Viral Syndrome will
get a rash.
Because Acute Viral Syndrome has such non-specific symptoms, it is very
difficult for us to assume these symptoms are in any way related to HIV
infection. That's why laboratory diagnosis is so important. So all I can
say is to suggest to the patient that they consider getting tested for HIV,
especially if they have put themselves at risk of infection. But symptoms
alone unfortunately tell us little when it comes to HIV infection, especially
since the symptoms associated with Acute Viral Syndrome are so variable and
non-specific. I hope this answered your questions.
If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide).
Rick Sowadsky MSPH CDS