In the latest Case Record of the Massachusetts General Hospital, a 19-year-old woman was seen in a clinic in South Africa because of headache, fatigue, sore throat, anorexia, and vaginal discharge. She had no history of STIs. Rapid testing for HIV-1 was negative. The initial symptoms resolved, but a painful genital ulcer developed.
With less than 1% of the world’s population, South Africa bears a disproportionate burden of global HIV infections (10% and 5.5 million people), which are predominantly sexually transmitted.
• What are the symptoms of acute HIV infection?
The acute retroviral syndrome occurs 2 to 3 weeks after infection, usually coinciding with the onset of viremia, and is accompanied by several nonspecific symptoms, including fatigue, pharyngitis, weight loss, myalgias, and headache.
• What are the diagnostic hallmarks of acute HIV infection?
The diagnostic hallmarks of acute HIV infection are a negative test for HIV-1 antibodies on enzyme immunoassay (EIA), an indeterminate or negative test for HIV-1 on Western blot analysis, and detection of HIV RNA in plasma.
Morning Report Questions
Q: Guidelines suggest treatment for which patients with HIV infection?
A: Currently, guidelines for most developed countries advocate treating asymptomatic HIV infection in patients who have a CD4 T-cell count below 500 cells per cubic millimeter, with many suggesting treatment at higher CD4 T-cell counts. World Health Organization guidelines take a more conservative approach, suggesting treatment at the threshold CD4 T-cell count of 350 cells per cubic millimeter for asymptomatic patients unless they are pregnant. South African guidelines recommend treatment for healthy patients with HIV infection who are not pregnant and have a CD4 count of 200 cells or less per cubic millimeter, due to the perceived costs and burden on available services.
Q: What is the prevalence of HIV in South Africa?
A: HIV in South Africa has evolved rapidly — despite a relatively late introduction to the virus — from a prevalence of 0.8% in the early 1990s to 26.5% by 2002, a percentage that has remained relatively stable. A large study involving South African adolescents suggests that 13.8% of 19-year-old women tested positive for HIV, and more than 30% tested positive by the age of 21 years.