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Acute and Recent HIV InfectionQuestion 5/10

A 24-year-old man who stopped taking HIV preexposure prophylaxis about 6 months ago is seen in clinic with a 2-day history of sore throat, severe fatigue, fever, and a diffuse erythematous macular rash. He reports condomless sex with several male partners during the last 4 weeks. A diagnosis of acute HIV is suspected.

Which one of the following laboratory results most strongly suggest this woman has acute HIV-1 infection?

Patients with recent HIV acquisition who present with an acute symptomatic illness (acute HIV) typically have a high HIV RNA level (as shown by the blue line), detectable p24 antigen (green line), and non-detectable anti-HIV antibodies (as shown by the purple line). The scenario of a high HIV RNA level combined with a negative HIV antibody test strongly suggests acute HIV.
Figure 1. Time Course of Detection of HIV RNA, p24 Antigen, and HIV Antibody Following Acquisition of HIV
Patients with recent HIV acquisition who present with an acute symptomatic illness (acute HIV) typically have a high HIV RNA level (as shown by the blue line), detectable p24 antigen (green line), and non-detectable anti-HIV antibodies (as shown by the purple line). The scenario of a high HIV RNA level combined with a negative HIV antibody test strongly suggests acute HIV.
Illustration: David H. Spach, MD
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Question Last Updated
April 26th, 2026

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