How is acute HIV infection diagnosed?

Updated: Sep 19, 2018
  • Author: David J Cennimo, MD, FAAP, FACP, AAHIVS; Chief Editor: Michael Stuart Bronze, MD  more...
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Early diagnosis of human immunodeficiency virus (HIV)–1 infection requires both sensitive and specific tests. Performance of available tests depends on the stage of the disease. The window period is defined as the time between the acquisition of infection and the development of detectable antibodies with the currently available assays.

Fiebig et al described 6 stages of the disease. [23, 52] After exposure, the virus remains in the exposed tissue without associated viremia, a period known as the eclipse phase, which lasts an average of 7 days. Currently, no routine detection method available for clinical use detects infection at this stage. The eclipse period is followed by the development of viremia, which can be detected with the available nucleic acid identification techniques. Identification of the viral nucleic acid is followed by detection of the p24 antigen and, lastly, antibodies.

Acute HIV-1 infection should be suspected in any patient with a negative or indeterminate HIV-1 serologic test result and a positive result on a nucleic acid amplification test or p24 antigen in the appropriate setting. The FDA [22] has approved a qualitative transcription-mediated amplification/hybridization protection assay (TMA/HPA) [47] for the screening or confirmation of HIV-1 infection, but not for both in the same individual. A 2009 report published by the APHL [40] states that a positive screening TMA/HPA result should be repeated for confirmation if an antibody response is not detectable and that the patient will need follow-up to document seroconversion.

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