HIV: Seroconversion

Key points

• HIV seroconversion is symptomatic in 60-80% of patients and typically presents as a glandular fever type illness. Increased symptomatic severity is associated with poorer long term prognosis.
• lymphadenopathy
• malaise, myalgia, arthralgia
• maculopapular rash
• rarely meningoencephalitis
• DIAGNOSIS of ACUTE/PRIMARY HIV: this is the setting where serology may still be negative or indeterminate. A fourth-generation test may already be reactive through p24 ANTIGEN before antibodies appear; where primary HIV is suspected, use a MOLECULAR assay (HIV RNA) via local virology pathways rather than relying on antibody testing alone (BHIVA/BASHH/BIA 2020). Diagnosis