Definition of Acute primary HIV infection

• High risk exposure within previous 2-8 weeks,
  
• and Clinical symptoms,
  
• and detectable HIV in the plasma (p24 Ag and/or HIV RNA > 10 000 c/ml)
  
• and negative or indeterminate serologic testing (negative or weakly positive ELISA, and WB ≤ 1 band)
  
• Recommendation: confirm HIV infection by HIV antibody test (WB) performed 3-6 weeks later.
  

Treatment:

• Treatment indicated if:
  
  • AIDS defining events
    
  • Confirmed CD4 <350/mm3 at month 3 or beyond
    
• Treatment should be considered if:
  
  • Severe illness/ prolonged symptoms (especially CNS symptoms)
    
• If treatment of PHI is considered, patient should be recruited into on-going clinical trial
  
• Treatment optional, as indication relies only on theoretical considerations. In most situations, wait till month 6 (with CD4 and plasma HIV-RNA monitoring) and follow criteria for initiation of treatment in chronic HIV infection. Some experts recommend treatment as a tool for prevention of HIV transmission.
  Duration of treatment: unknown but maybe should be lifelong.
  Maintain closer follow-up in case of treatment interruption.

Resistance testing:

• Recommended in all situations as soon as acute HIV infection is diagnosed, even if treatment not initiated
  
• In case it cannot be performed, store blood for further testing.
  

Transmission:

• Recognize sexually transmitted infections (STIs), including syphilis, gonorrhoea, Chlamydia (Urethritis and LGV), HPV, hepatitis B and hepatitis C.
  
• Counsel newly diagnosed patient on high risk of transmission and preventive measures (condoms) including notifying and testing partners.