Primary HIV infection case presentations

The following cases illustrate the complexities involved in recognizing and correctly diagnosing primary HIV infection (PHI). Extensive lab work, but also thorough history taking, is required. Patient 1 was not recognized as suffering from PHI until after she was discharged from the hospital. Patient 2 was recognized with PHI, and his symptoms spontaneously resolved. Patient 3 required extensive hospitalization because of pulmonary complications. Viral loads declined sharply without medication for both patients 1 and 2, upon resolution of symptoms. However, patient 3 maintained a high viral load and was started on triple-drug antiretroviral therapy. None of the patients were started on antiretroviral therapy during the acute retroviral syndrome phase of PHI, which is currently recommended in US treatment guidelines.