The weeks following HIV infection are a highly dynamic period, with a series of virologic and immunologic events having occurred prior to the onset of clinical manifestations of PHI and the emergence of positive findings on diagnostic tests. An exceedingly high plasma HIV viral load and rapid loss of CD4+ T cells in all tissue …
It is difficult to precisely determine what proportion of people with PHI experience symptoms, though this is reported to be in the range of 23-92% of infected individuals14. The presence of symptoms during PHI is predictive of long-term outcomes, with greater severity associated with more rapid disease progression15, 16. Often these symptoms are non-specific in …
Clinical manifestations of primary HIV infection Read More »
Fourth generation HIV immunoassays and NATs have enabled identification of people with PHI prior to the development of HIV-specific antibodies, however these methods entail blood collection and laboratory testing and may be inconvenient for the person being tested. Point-of-Care (POC) or rapid tests, first introduced into Australia in 2018, are screening tests performed independent of …
Resistance of HIV to antiretroviral drugs is an important cause of treatment failure, which is covered in detail in the section entitled Virological tests for diagnosing and monitoring HIV infection. Acquisition of drug resistance mutations depends on the interplay between factors such as patient adherence to treatment, drug potency, genetic barrier to resistance, host genetics, and …
Antiretroviral drug resistance testing in primary HIV infection Read More »
Upon diagnosis of PHI, there must be clear communication to the patient, in combination with counselling regarding the importance of safe practices to prevent further spread of infection. During the months following PHI, there is an extremely high HIV viral load in the blood and genital tract. Individuals with PHI contribute disproportionately to HIV transmissions; …
Primary HIV infection is a critical period in which the virological and immunological events that take place, even before the onset of clinical symptoms, may determine the long-term outcome of disease. Early recognition of symptoms, especially in people deemed to be high-risk individuals, is critical. Understanding the pathophysiology of PHI allows appropriate selection of diagnostic …
1. Streeck H, Nixon DF. T cell immunity in acute HIV-1 infection. J Infect Dis. 2010;202 Suppl 2:S302-8. DOI: 10.1086/655652. 2. Hu J, Gardner MB, Miller CJ. Simian immunodeficiency virus rapidly penetrates the cervicovaginal mucosa after intravaginal inoculation and infects intraepithelial dendritic cells. J Virol. 2000;74(13):6087-95. DOI: 10.1128/jvi.74.13.6087-6095.2000. 3. Moore JP, Kitchen SG, Pugach P, …
Andrew McLean-Tooke1, Martyn French2 Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, WA UWA Medical School and School of Biomedical Sciences, University of Western Australia, Perth, WA Last Reviewed: September 2019 Introduction In addition to clinical and virological staging of HIV infection, patients should be staged immunologically as this provides prognostic information for the …
Immunological tests used to monitor HIV infection and disease Read More »
In patients with HIV infection not receiving antiretroviral therapy (ART), the blood CD4+ T cell count or proportion (CD4+ T cells as a percentage of total lymphocytes) should be monitored because they relate to the extent of HIV disease and guide the use of prophylactic antimicrobial therapy to prevent opportunistic infections. However, there is limited …
Routine monitoring of blood lymphocyte subpopulations in people with HIV infection Read More »
In addition to measuring the blood count or proportion of total CD4+ T cells or CD4+ T cell subpopulations, it is also possible to assess the proportion of blood T cells that specifically respond to HIV antigens. Whilst this type of test is not used in the routine clinical setting, it has utility in research settings for …