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Acute and Recent HIV InfectionQuestion 5/10

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A 21-year-old woman presents to an urgent care center with a 24-hour history of fever, sore throat, severe fatigue, and a diffuse erythematous macular rash. She states that about 2 to 3 weeks ago, she had condomless vaginal sex with a new male partner. A diagnosis of acute HIV is suspected.

From a laboratory diagnostic standpoint, which one of the following results would most strongly suggest this woman has acute HIV-1 infection?

Patients with recent HIV acquisition who present with an acute symptomatic illness (acute HIV) typically have a high HIV RNA level (as shown by the blue line), detectable p24 antigen (green line), and non-detectable anti-HIV antibodies (as shown by the purple line). The scenario of a high HIV RNA level combined with a negative HIV antibody test strongly suggests acute HIV.
Figure 1. Time Course of Detection of HIV RNA, p24 Antigen, and HIV Antibody Following Acquisition of HIV
Patients with recent HIV acquisition who present with an acute symptomatic illness (acute HIV) typically have a high HIV RNA level (as shown by the blue line), detectable p24 antigen (green line), and non-detectable anti-HIV antibodies (as shown by the purple line). The scenario of a high HIV RNA level combined with a negative HIV antibody test strongly suggests acute HIV.
Illustration: David H. Spach, MD
Using the HIV testing algorithm as recommended by the Centers for Disease Control and Prevention and Association of Public Health Laboratories, persons with acute HIV-1 will likely have a pattern consisting of a positive HIV-1/2 antigen-antibody immunoassay, a negative HIV-1/HIV-2 antibody differentiation immunoassay, and a positive HIV-1 nucleic acid test (HIV-1 RNA). This typical pattern seen in persons with acute HIV-1 is highlighted by the yellow borders around the boxes.
Figure 2. Acute HIV Results Using the HIV Testing Algorithm as Recommended by CDC and APHL
Using the HIV testing algorithm as recommended by the Centers for Disease Control and Prevention and Association of Public Health Laboratories, persons with acute HIV-1 will likely have a pattern consisting of a positive HIV-1/2 antigen-antibody immunoassay, a negative HIV-1/HIV-2 antibody differentiation immunoassay, and a positive HIV-1 nucleic acid test (HIV-1 RNA). This typical pattern seen in persons with acute HIV-1 is highlighted by the yellow borders around the boxes.
Source:
Centers for Disease Control and Prevention and Association of Public Health Laboratories. Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations. Published June 27, 2014.
Centers for Disease Control and Prevention and Association of Public Health Laboratories. 2018 Quick reference guide: Recommended laboratory HIV testing algorithm for serum or plasma specimens. Published January 27, 2018.
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Question Last Updated
January 28th, 2025

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