Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
A
0%
0/0
B
C
D
E
Select Answer to see Preferred Response
This patient with mononucleosis-like symptoms (sore throat, headache, myalgia, fatigue, cervical lymphadenopathy), negative heterophile antibody test, and recent unprotected sexual intercourse most likely has acute HIV infection. Patients in the window period of acute HIV infection would be expected to have negative testing for HIV antibody, positive testing for p24 antigen, and markedly elevated levels of HIV RNA. HIV testing should be performed in patients with clinical signs of acute HIV infection (flu-like symptoms such as fever, lymphadenopathy, malaise), as well as patients with possible exposure to HIV. Testing includes HIV viral RNA titers, antibodies against HIV, and p24 antigen (a capsid structural protein of HIV). In acute HIV infection, HIV RNA will first become detectable around 1 week. Subsequently, the p24 antigen will become detectable around 10 days. HIV antibodies will then become detectable around 2-3 weeks. Levels of p24 antigen will decrease after 3-4 weeks as antibody titers rise. Therefore, routine testing for HIV should include a fourth-generation combination HIV-1/2 immunoassay that detects both HIV antibodies and HIV p24 antigen. In addition, patients for whom there is a concern for acute HIV infection should also receive testing for HIV RNA. Hurt et al. review the timeline of HIV infection, nomenclature, and characteristics of different tests for HIV, and compare point-of-care and laboratory-based tests. Figure A presents the possible answers choices for this question. Values for HIV-1 antibody, p24 antigen, and HIV RNA titers are shown in the table. Incorrect Answers: Answer 1: Negative testing for HIV-1 antibody, negative p24 antigen, and elevated HIV RNA titers would be found approximately 5-10 days after acute HIV infection. This patient experiencing symptoms and who is in the window period of acute HIV infection would also be expected to have a positive p24 antigen test. Answer 3: Positive testing for HIV-1 antibody, negative p24 antigen, and elevated HIV RNA titers may be found approximately 3 weeks after acute HIV infection. The p24 antigen becomes undetectable in 2/3 of patients after the first several weeks of acute HIV infection, while other testing remains positive. In this patient who was most likely infected 10 days ago, the p24 antigen would be expected to be positive. Answer 4: Positive testing for HIV-1 antibody, positive p24 antigen, and elevated HIV RNA titer may be found after approximately 2-3 weeks after acute HIV infection or very late in the disease course. In this patient in the window period of acute HIV infection, immunoassay for HIV-1 antibody would not yet be expected to be positive. Answer 5: Positive testing for HIV-1 antibody, positive p24 antigen, and undetectable HIV RNA titer would not be expected in acute HIV infection. HIV RNA levels are elevated first in acute HIV infection; they may decline after acute HIV infection, but this would be expected to happen after the p24 antigen is no longer detectable. Bullet Summary: Patients in the window period of acute HIV infection will have elevated HIV RNA titers, positive p24 antigen, and undetectable HIV antibody.
0.0
(0)
Please Login to add comment