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Meningoencephalitis due to primary HIV infection

BMJ 2003; 326 doi: (Published 08 March 2003) Cite this as: BMJ 2003;326:552

HIV infection may also cause rash or glandular fever type illness

  1. Mark Melzer, specialist registrar in infectious diseases (,
  2. Shiobhan O'Shea, academic virologist,
  3. Ian Chrystie, academic virologist,
  4. Jangu Banatvala, emeritus professor of clinical virology
  1. Wharfside Clinic, St Mary's Hospital, London W2 1NY
  2. Guy's, King's College, and St Thomas's School of Medicine and Dentistry, London SE1 7EH
  3. Wigtown, Wigtownshire DG8 9DZ

    EDITOR—Newton et al describe how meningoencephalitis was caused by primary HIV infection, and we agree with them that a high index of suspicion is required for diagnosis.1 A more common presentation in unconfused patients is a maculopapular rash or a glandular fever type illness, which provides an opportunity for early counselling and HIV testing without ethical constraints. 1 2 In south London we recently showed that primary HIV infection remains undiagnosed in patients with a rash or a glandular fever type illness caused by HIV.

    Between May 1998 and April 1999, with ethics approval, we retrospectively and anonymously tested 268 stored serum samples for HIV. The samples had been sent to the virology laboratory at St Thomas's Hospital and were from patients aged …

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