The period immediately after initial exposure to the virus

Clinical features

Most people with primary HIV infection clinical experience a mild flu-like illness 2-6 weeks after infection, which can range from a mild glandular fever to an evolving encephalopathy

Classically, patients present with fever and lymphadenopathy. Other common features are a maculopapular rash, found commonly on the upper chest, and mucosal ulcers. Other symptoms may include myalgia, arthralgia and fatigue.

Onset of symptoms within 3 weeks of infection that last for longer than 2 weeks or that involve the CNS are associated with a rapid progression to AIDS.

Asymptomatic infection may also occur.

Diagnosis

Diagnosis is via serum HIV enzyme-linked immunosorbent assay (ELISA), with a positive result confirmed using a second test.

Additional tests should include a:

• HIV viral load
• full blood count
• lymphocyte subset panel including CD4 count
• screening for other sexually transmitted infections such as chlamydia, gonorrhoea and syphilis
• screening for viral hepatitis
• kidney function
• liver function
• glucose
• lipids