A. AIDS – This not the correct answer

June 20, 2013

This patient has had unprotected sexual intercourse with numerous partners, which increases the likelihood of acquiring a sexually transmitted infection – including HIV, Hepatitis B and C, and syphilis.

This patient has had unprotected sexual intercourse with numerous partners, which increases the likelihood of acquiring a sexually transmitted infection – including HIV, Hepatitis B and C, and syphilis.

Primary HIV infection may present with a low grade fever, headache, and a disseminated rash; however, it but does not present with focal vesicular lesions. When cellular (T-cell mediated) immunity has been severely compromised by the HIV virus, the individual is susceptible to standard/opportunistic infections and rare cancers, such as Kaposi’s sarcoma.

This patient clearly has risk factors for HIV/AIDS.  However, while a worthwhile consideration in this case, HIV/AIDS alone would be an incomplete answer. Our patient had additional symptoms of severe headache, ear pain, positive jolt test,  photophobia, and painful, focal vesicular lesions that indicate the presence of an acute infection or disease/viral reactivation.  Any young patient with a vesicular rash that suggests varicella zoster or herpes simplex should be evaluated for HIV; both of these viral infections are AIDS-defining illnesses. 

During acute HIV infection, HIV viral particles circulate, but anti-HIV antibodies do not develop for several weeks. During this “window phase,” standard antibody screening test results are negative; a simple HIV RNA viral load assay is therefore the test of choice. The development of overt AIDS takes years. Therefore, if you suspect an AIDS-defining illness, such as varicella zoster virus infection, the patient is unlikely to be in the window phase of acute HIV and is more likely presenting with late-stage HIV. As such, HIV antibody screening test should be adequate.

We checked the HIV viral load in our patient to definitively rule out HIV/AIDS disease. Test results were negative.

To return to the case, please click here.