A 27-year-old man has fever, macular rash, and lymphadenopathy. He had unprotected sex with a male partner 2 weeks before the onset of these symptoms and has just learned that the partner is infected with HIV. The patient’s rapid HIV test is negative. What is the best test to evaluate this patient for HIV infection?
A. HIV enzyme-linked immunoabsorbent assay (ELISA)HIV infection is usually diagnosed by the detection of HIV-specific antibodies using rapid HIV test or a conventional enzyme-linked immunoabsorbent assay (ELISA), which are highly sensitive tests, and confirmed by Western blot or indirect immunofluorescence assay, which are highly specific tests. Antibodies appear in few weeks after infection, sometimes after the development of acute HIV infection (acute retroviral syndrome). Clinicians should maintain a high level of suspicion for acute HIV infection in all patients who have a compatible clinical syndrome and who report recent high-risk behavior. When acute retroviral syndrome is a possibility, a plasma RNA polymerase chain reaction (PCR) should be used in conjunction with an HIV antibody test to diagnose acute HIV infection. Although HIV DNA testing is available, it offers no added advantages over the more readily available and FDA-approved HIV RNA testing. The patient’s HIV serology (antibody testing) is negative, so repeating the serology testing by ELISA or ordering Western blot is not indicated at this point. It is appropriate to repeat the serology testing in 4 to 6 weeks.