Acute HIV Syndrome

Acute HIV syndrome:
- Occurs in 50-70% of individuals with HIV, and in this patient could have been his initial presentation (not GAS).
- anywhere from 6 days to 6 weeks after primary infection
- DDx includes EBV, CMV, viral hepaitis, enteroviral infection, secondary syphilis, toxo, HSV, drug reaction etc
- Findings: Fever (97%), erythematous maculo-papular rash (77%), pharyngitis (73%), myalgias/arthralgias (58%), LAN, H/A, retroorbital pain, lethargy/malaise, anorexia/weight loss, N, V, D, meningitis, encephalitis, peripheral neuropathy.
- Lab findings: lymphopenia then lymphocytosis, thrombocytopenia, elevated transaminase, depressed CD4 count, HIV AB usually negative-- so check Viral load.

Eosinophilia in HIV can be from direct HIV effect especially if advanced, drug allergy (think bactrim or other sulfas), or less commonly parasitic infection. This is less common bc most HIV associated parasites (toxo, crypto) DON'T cause eosinophilia. If in an endemic area you might think of isospora or strongyloides.

(Katharine Cheung MD, 11/14/10)