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Acute and Recent HIV InfectionQuestion 9/10

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A 33-year-old cisgender man is seen in the emergency room with fever, cervical lymphadenopathy, and a diffuse macular erythematous rash. About 2 weeks prior, he had condomless receptive and insertive anal sex with a male partner of unknown HIV status. An HIV-1/2 antigen-antibody immunoassay is negative, but an HIV RNA is ordered because acute HIV is strongly suspected. The HIV RNA is 362,000 copies/mL. He is diagnosed with acute HIV.

Which one of the following statements best describes HIV infection of the gut-associated lymphoid tissue (GALT) during acute HIV?

This illustration shows abundant CD4 cells in the gut-associated lymphoid tissue in persons without HIV.
Figure 1. Gut-Associated Lymphoid Tissue in Persons Without HIV
This illustration shows abundant CD4 cells in the gut-associated lymphoid tissue in persons without HIV.
Illustration: David Spach, MD
As shown in this illustration, within 3 weeks after HIV acquisition, there is massive depletion of the CD4 cells in the gut-associated lymphoid tissue.
Figure 2. Depletion of Gut-Associated Lymphoid Tissue Soon After Acquisition of HIV
As shown in this illustration, within 3 weeks after HIV acquisition, there is massive depletion of the CD4 cells in the gut-associated lymphoid tissue.
Illustration: David Spach, MD
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Question Last Updated
September 19th, 2023

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