Practice Easily Missed?

Primary HIV infection

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4583 (Published 06 September 2010) Cite this as: BMJ 2010;341:c4583
  1. Gautam Das, specialist registrar,
  2. Piero Baglioni, consultant physician,
  3. Onyebuchi Okosieme, consultant physician
  1. 1Prince Charles Hospital, Gurnos, Merthyr Tydfil CF47 9DT
  1. Correspondence to: G Das drgdas{at}gmail.com
  • Accepted 21 July 2010

Primary HIV infection encompasses the biological and clinical manifestations of the period between initial contact with the virus and the appearance of specific antibodies.1

Case scenario

A previously healthy 19 year old man was admitted to our medical ward with a history of fever, sore throat, and a maculopapular rash on his trunk. An upper respiratory tract infection had been diagnosed in the community a few days before. A monospot test (for infectious mononucleosis caused by Epstein-Barr virus) was negative, and he initially denied risky sexual behaviour and declined an offer of HIV testing. His symptoms improved, but before discharge he mentioned to the ward sister that he had had a casual sexual encounter with a man a few weeks earlier. He then consented to an HIV test, which was positive for the p24 antigen.

How common is primary HIV infection?2

  • Symptoms are present in 50-90% of individuals with primary HIV infection1

  • During 2008 there were 7298 new diagnoses of HIV in the United Kingdom. In the same year, 27% of the estimated 83 000 people with HIV were thought to be unaware of their infection (because many people only realise they have HIV infection when they develop full blown AIDS)

  • The two groups with the highest HIV prevalence in the UK are men who have sex with men, and black African heterosexuals. The number of new infections acquired heterosexually increased by 53% (from 740 to 1130 cases) from 2004 to 2008

  • The estimated numbers of new infections acquired through injecting drug use and mother to child transmission (170 and 110 cases respectively in 2008) have remained stable since the start of the epidemic

Why is primary HIV infection missed?

Primary HIV infection is symptomatic in most individuals but is easy to miss.3 4 In a …

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