Clinical features of the seroconversion illness

Clinical features of primary HIV infection (PHI) are present in over 60% of patients.

• in majority, acute illness develops within 1-4 weeks after initial infection and the symptoms persist for 2-4 weeks post exposure
• symptoms are thought to correlate with peak viremia (1,2)

Clinical features of PHI usually resemble mononucleosis or influenza-like illness. Two studies have reported an HIV prevalence of 3.9% & 1.3% in patients presenting with monnucleosis type symptoms

• most prevalent symptoms are:
  • fever
  • fatigue
  • myalgias/arthralgias
  • rash (typically an erythematous maculopapular exanthem)
  • sore throat
  • lymphadenopathy
  • oral, genital or perianal ulcers (1,3)

In addition patients may also present with less common features:

• headache or meningitis
• cranial nerve palsies
• diarrhoea
• weight loss (3)

A patient may have acute conditions associated with immunosupression due to an acute drop in CD4 count such as.

• oral candidiasis
• shingles
• other conditions associated with immunodeficiency (3)

Reference:

• (1) Chu C, Selwyn PA. Diagnosis and initial management of acute HIV infection. Am Fam Physician. 2010;81(10):1239-44.
• (2) Griswold J, Tungsiripat M. HIV for primary care physician. Cleveland clinic, Center for continuing education 2017
• (3) The Medical Foundation for AIDS & Sexual Health (MedFASH) 2016. HIV in primary care. A practical guide for primary healthcare professionals in Europe.