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September 2015
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What We're Reading
Many Individuals With ARS Do Not Experience Typical Symptoms
Christopher Hoffmann, MD, MPH, Johns Hopkins University School of Medicine

Early HIV diagnosis and initiation of antiretroviral therapy (ART), a pillar of HIV care and prevention, can be achieved by testing individuals to identify those with acute HIV infection. A study just published by Braun and colleagues, from University of Zurich, Switzerland, describes their experience from 2002 to 2013 with identifying symptoms of recent HIV infection (CID 2015:61; 15 September). The researchers analyzed data acquired from follow-up of individuals diagnosed with acute or recent HIV infection. Although the authors acknowledge that their method of recruitment may have produced an underestimation of the proportion of individuals with atypical symptoms or no symptoms, their results are informative. Among participants who sought care for symptoms of acute infection, HIV was suspected for only 38% on their first visit. Most (70%) participants had "typical" acute HIV infection symptoms, which prompted testing. Of those with typical symptoms, fever, malaise, and pharyngitis were most common (51% to 88%), with rash and lymphadenopathy occurring among 47% and 45%, respectively. Headache, night sweats, myalgia, arthralgia, and nausea were reported among 22% to 37%. Notably, 25% of participants only had "atypical" symptoms (generally gastrointestinal or central nervous system symptoms). Several opportunistic illnesses were also documented, including candida esophagitis, CMV colitis, gastritis, and hepatitis (one each), and zoster. This collection of gastrointestinal and CNS symptoms is similar to prior reports of atypical acute HIV symptoms. From a clinical perspective, this study is a reminder that many, possibly most, individuals with acute retroviral syndrome do not experience typical symptoms. (Read abstract on PubMed)
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