ASPEN, COLO. — A rash in a teenager with an apparent viral syndrome should raise the diagnostic possibility of acute retroviral syndrome because of a recently acquired HIV infection, Dr. Elizabeth McFarland said at a conference on pediatric infectious disease sponsored by Children's Hospital, Denver.
HIV infection “is not necessarily a rare disease,” said Dr. McFarland, director of the Children's Hospital (Denver) HIV program.
About 40,000 new cases of HIV infection occur annually in the United States, and half of them may affect teenagers. Moreover, those patients do come for medical attention.
In one urgent-care center in Boston, 1% of adults who presented with any viral symptoms had acute HIV, she noted. In a university hospital in the same city, almost 1% of persons tested for mononucleosis had acute HIV infection.
Similarly, in an emergency department in North Carolina, 0.3% of all people presenting with fever had acute HIV infection.
The most distinctive symptoms seen with acute HIV infections are rash, thrush, and neurologic symptoms, Dr. McFarland said. Around 2 weeks after exposure, 40%–90% of those newly infected with HIV will have symptoms; 96% of them will have fever, 74% will have lymphadenopathy, 70% will have pharyngitis, and 70% will have rash.
As the fourth most common symptom and the only relatively uncommon one in a patient with an apparent viral illness, rash should trigger suspicion of HIV.
The appearance of the skin rash is not notable, but mouth ulcers often are also present or may occur alone.
The thrush and neurologic symptoms are not common, but like the rash, they are unusual for a viral illness. Both are seen in 12% of newly infected patients.
Other symptoms include myalgia or arthralgia (54%), diarrhea (32%), headache (32%), and nausea and vomiting (27%).
“If they have compatible symptoms, it really is reasonable to test” patients for human immunodeficiency virus, Dr. McFarland urged.
Around 2 weeks after exposure, 40%–90% of those newly infected with HIV will have symptoms. DR. MCFARLAND