Symptomatic Seroconversion?

Question

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!

Answer

Hi. Thank you for your questions. First, let me review with you the symptoms associated with recent HIV infection.

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