A 39-year-old man presented to the emergency department with a 7-day history of fever and rash. He reported same-sex relationships involving condomless anal sex, and did not use pre- or postexposure HIV prophylaxis. Physical examination found a temperature of 38[degrees]C, cervical lymphadenopathy, mucosal ulceration on his tongue and a maculopapular rash on his face, neck and anterior chest (Figure 1). Suspecting primary HIV infection, we performed a rapid plasma reagin test, which returned a negative result. A chemiluminescent immunoassay was positive for HIV antibodies, but the reactive immunoassay using Western blotting showed no reactivity. The patient's HIV-1 blood viral load was 4.79 million copies/mL with a blood CD4 T-cell count of 0.1 * [10.sup.9]/L. We diagnosed acute HIV infection and started antiretroviral treatment with bictegraviremtricitabine-tenofovir alafenamide.
Features of acute HIV infection occur 2-4 weeks after exposure; seroconversion usually occurs 3-8 weeks...