Background: Diagnosis of acute HIV infection is challenging and has important clinical and public health implications. Initiating ART during acute HIV infection decreases viral replication and may affect HIV-specific immune responses. On a public health level, diagnosis and treatment of acute HIV infection may reduce further spread of infection.

Methods: The Duke–UNC Acute HIV Infection Research Consortium enrolls adult patients diagnosed within 30 days of HIV seroconversion. We examined a prospective cohort of 110 persons diagnosed from January 1998 to September 2007 to determine characteristics associated with acute HIV infection diagnosis including demographics, site of initial presentation, number of health care visits before diagnosis, and diagnosing clinician. Diagnosis was considered to have been made when a diagnostic test was ordered (usually HIV RNA by polymerase chain reaction).

Results: Complete data were available on 99 of 110 persons: 50 were white (45 male, 5 female), 49 nonwhite (40 male, 9 female); median age, 31 years (range 18 to 62). Acute HIV infection was diagnosed by voluntary counseling and treatment programs (STAT) in 47 patients (20 white, 27nonwhite) and via clinical care in 52 patients (30 white, 22 nonwhite). A higher proportion of white patients (30 of 50 [60%]) was diagnosed clinically than nonwhite patients (22 of 49 [45%]). Among clinically diagnosed cases, self-identified HIV risk behaviors were injecting drug use (2), men having sex with men (38), and heterosexual exposure (12). White patients were equally likely to present to a routine care setting (primary care provider, student health clinic) or to an urgent care setting (emergency department, urgent care clinic)—15 of 30 (50%) for each. Nonwhite patients were more likely to present to an urgent care setting—17 of 22 (77%). Symptoms at presentation were typical of acute HIV infection—fever (83%), myalgia (58%), fatigue (55%), and nausea and vomiting (55%). Most patients were not diagnosed at presentation; 42 of 52 (81%) required more than 1 visit (median 2, range 1 to 4). Of those diagnosed at first encounter 8 of 10 were nonwhite and 7 of 10 were diagnosed in urgent care settings (most occurred after patients were admitted-considered an extension of the initial presentation). Consulting Infectious Diseases physicians made most diagnoses (58%).

Conclusions: Although most persons diagnosed in our cohort presented to clinical care settings with symptoms of acute HIV infection, early diagnosis was uncommon. Increased awareness of acute HIV infection symptoms among primary care and emergency department providers might increase acute HIV infection testing and diagnosis. This could favorably affect HIV transmission and potentially facilitate appropriate early ART initiation.