engleski

Early diagnosis of an acute HIV infection in a primary care setting: the opportunity for early treatment and prevention

Many countries have recently placed significant emphasis on the identification of people with acute HIV infection. In our case we have shown that an early HIV infection can still be missed, in spite of clinical suspicion, by using immunoblot as the sole confirmatory method in patients with an early HIV infection in whom only the HIV antigen is detectable and antibodies have not yet been produced. We can conclude that, in cases of leucopenia with thrombocytopenia and fever, an acute HIV infection has to be considered as the differential diagnosis and should be excluded. For the diagnosis of an early HIV infection, fourth-generation EIA should replace the third-generation and NAT for HIV should be introduced into the confirmatory algorithm at the first sample stage in addition to the standard HIV fourth-generation EIA if the confirmatory immunoblot is negative. In patients with reactive fourth-generation HIV EIA, with or without clinical illness, a negative immunoblot result should be followed by NAT. This would optimise early HIV diagnosis without a significant cost increase, considering the benefits accruing in terms of opportunities for earlier treatment, source identification and introduction of preventive measures.

Early diagnosis; acute HIV-infection; primary care setting

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