A 31-year-old man comes to the office due to a week of fever, night sweats, sore throat, malaise, and extreme fatigue. He has no prior medical conditions and takes no medications. The patient has had multiple sexual partners over his lifetime and uses condoms inconsistently. Temperature is 38 C (100.4 F), blood pressure is 110/80 mm Hg, pulse is 92/min, and respirations are 20/min. Physical examination shows multiple shallow ulcers on the oropharyngeal mucosa, and the tonsils are enlarged and hyperemic. Cervical and axillary lymphadenopathy is present, and there is a generalized, erythematous, maculopapular skin rash. HIV testing shows the following results: Which of the following best explains this patient's laboratory findings?

Question

A 31-year-old man comes to the office due to a week of fever, night sweats, sore throat, malaise, and extreme fatigue.  He has no prior medical conditions and takes no medications.  The patient has had multiple sexual partners over his lifetime and uses condoms inconsistently.  Temperature is 38 C (100.4 F), blood pressure is 110/80 mm Hg, pulse is 92/min, and respirations are 20/min.  Physical examination shows multiple shallow ulcers on the oropharyngeal mucosa, and the tonsils are enlarged and hyperemic.  Cervical and axillary lymphadenopathy is present, and there is a generalized, erythematous, maculopapular skin rash.  HIV testing shows the following results:  Which of the following best explains this patient's laboratory findings?

Quizplus · Accepted Answer

Eductional Objective: Initial HIV infection is often associated with mononucleosis-like symptoms (eg, fever, lymphadenopathy, sore throat) 2-4 weeks after transmission.  Important diagnostic clues are oropharyngeal ulcers and a diffuse maculopapular rash.  As the humoral antibody response is not fully activated early in infection, laboratory results typically show HIV in the serum (positive viral load and p24 antigen) but negative HIV serology.

A 31-Year-Old Man Comes to the Office Due to a Week