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Primary HIV Infection
DIAGNOSIS: HIV RNA >10,000 c/mL + indeterminate or negative HIV serology or recent seroconversion (Ann Intern Med 2001;134:25). The diagnosis of recent infection can sometimes be made by a combination of standard serology (which will be reactive) plus the “detuned” serologic test (not commercially available), which is less sensitive than standard serology and consequently negative for an average of 170 days post-infection (JAIDS 2003;33:625). This implies utility in detecting early disease but not acute infection. For mass screening, seronegative specimens can be pooled for PCR testing, with PCR testing of individual samples from any batch that tests positive (NEJM 2005;352:1873). When this method was used at counseling and testing sites in North Carolina, acute infections accounted for 4% to 10% of all newly detected HIV infections (NEJM 2005;352:1873; JAIDS 2006;42:75). Other studies suggest that 40-45% of all transmissions occur during this early period during which the viral load is high and individuals are usually unaware that they are infected.(JID 2005;191:1403; JID 2007;195:951)
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TABLE 1-1: Natural history of HIV infection (Lancet 2006;368:489)