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Acute and early HIV infection: Clinical manifestations and diagnosis

Paul E Sax, MD
Section Editor
John G Bartlett, MD
Deputy Editor
Allyson Bloom, MD


Acute HIV infection may present as a mononucleosis type of syndrome with a constellation of nonspecific symptoms. Without a high degree of suspicion, the diagnosis can frequently be missed by clinicians. In some cases, early HIV infection may be asymptomatic.

The clinical manifestations and diagnosis of acute and early HIV will be reviewed here. The pathogenesis, epidemiology, and treatment of early HIV infection are discussed separately. (See "Acute and early HIV infection: Pathogenesis and epidemiology" and "Acute and early HIV infection: Treatment".)


Different terms, including acute, recent, primary, and early HIV infection, have been used in the literature to refer to variable intervals following initial infection with the virus. In this topic, we use the term "early HIV infection" to refer to the approximate six-month period following HIV acquisition. We use the term "acute HIV infection" to refer to symptomatic early infection, as this reflects common usage in clinical care.


Asymptomatic infection — An estimated 10 to 60 percent of individuals with early HIV infection will not experience symptoms [1], although the exact proportion is difficult to estimate since patients generally come to attention because of symptoms, and thus asymptomatic infections often remain undetected. In a study of 50 acutely infected individuals who had been identified by prospective viral testing of high-risk individuals and then were followed twice weekly, almost all had at least one reported symptom or sign during the first four weeks of infection, but these were mainly short-lived, nonspecific, and unlikely to have brought the individual to clinical attention outside of a study setting [2]. Subjects complained of symptoms at only 29 percent of the biweekly study visits during this period.

Time course — In patients who have acute symptomatic infection, the usual time from HIV exposure to the development of symptoms is two to four weeks, although incubation periods as long as ten months have been observed [3]. In one study that evaluated viral dynamics following HIV infection, the highest frequency of symptoms and signs were observed just before peak viremia occurred, approximately two weeks after the initial detection of viral RNA [2]. It is possible that the route of acquisition and quantity of virus inoculum influence the time to peak viremia and the length of the incubation period.

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Literature review current through: Dec 2017. | This topic last updated: Apr 19, 2017.
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