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|Fever in a traveller
|Malaria Falciparum
|Malaria Non-Falciparum
|Viral Haemorrhagic Fevers (VHF)
|Lassa fever
|Dengue
|Marburg virus disease
|AIDS HIV
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|Incubation Periods
|Notifiable Diseases UK
- Acute Retroviral Syndrome (HIV) 🦠: The highly infectious early stage of HIV. Symptoms usually last around 2–3 weeks.
- Often mistaken for “flu-like” or glandular fever–like illness, leading to delayed recognition.
🧬 Aetiology
- HIV replicates aggressively within CD4+ T cells, causing their depletion and initiating long-term immune dysfunction.
- During acute infection, viral load is extremely high ➝ transmission risk greatest. ⚠️
🩺 Clinical Features
- Systemic: Fever 🌡️, malaise, arthralgia (joint pain), myalgia.
- Skin: Generalised morbilliform rash 🌸.
- ENT: Pharyngitis, painful lymphadenopathy (often generalised) 🤒.
- CNS: Aseptic meningitis, headache, photophobia, sometimes neuropathy 🧠.
- Opportunistic infections are rare at this stage, but history of risk factors (IVDU 💉, unprotected sex) is key.
- Features of advanced HIV (e.g., Kaposi’s sarcoma, oral thrush, hairy leukoplakia) ➝ suggest progression to AIDS stage.
Differential Diagnoses
- Glandular fever (EBV, CMV) – overlaps with fever, rash, lymphadenopathy; distinguished by serology.
- Other viral illnesses (e.g., influenza, adenovirus, enteroviruses).
🔎 Investigations
- Bloods: FBC, WCC, CRP may be raised. LFTs often deranged. Atypical lymphocytes ± thrombocytopenia 🧪.
- Imaging: CXR usually normal (PCP is rare this early).
- Viral load: Very high (>10 million copies/mL) during acute infection.
- HIV antibody testing: Often negative in the first 2–4 months (“window period”).
- HIV RNA (PCR): Detectable earlier (gold standard for diagnosis in acute phase) ⚡.
- Monospot test: May help exclude EBV/CMV if diagnostic uncertainty.
💊 Management
- Supportive care during acute illness (hydration, analgesia, rest).
- Counselling: Advise strict avoidance of unprotected sex until confirmatory testing is complete ➝ highest infectivity window 🛑.
- Discuss antiretroviral therapy (ART): Modern guidelines support early initiation of ART in confirmed acute HIV ➝ improves prognosis and reduces transmission.
- Without treatment ➝ gradual CD4 decline over ~10 years ➝ opportunistic infections, renal disease, malignancy. Faster progression in older patients ⏳.
References
