History

The clinical manifestations observed for acute HIV infection are numerous, and multiple systems can be affected. The discussion below outlines the historical course and physical findings of the conditions observed in acute HIV infection. Oral lesions, including thrush, hairy leukoplakia, and aphthous ulcers, are particularly common during this stage of HIV infection.

• Persistent generalized lymphadenopathy: Patients have a history of enlarged lymph nodes (>1 cm) involving 2 or more extrainguinal sites for more than 3 months without an obvious cause.
• Oral lesions
  • Thrush may be present.
  • Patients may have oral hairy leukoplakia.
  • Herpes simplex virus (HSV) lesions may be present and can be painful.
  • Reactivation of herpes zoster (shingles) occurs in patients infected with HIV, with a relapse rate of approximately 20%.
  • Aphthous ulcers are shallow and painful and typically affect the posterior oropharynx.
• Hematologic
  • Anemia may be present, and patients usually present with fatigue and malaise.
  • Thrombocytopenia may also be an early consequence of HIV infection, but typically it is not symptomatic. Bleeding of the gums, extremity petechiae, and easy bruising are common presenting features in patients with clinically significant thrombocytopenia.
• Neurologic manifestations: These result in significant morbidity for patients infected with HIV.
  • These manifestations may be either primary (ie, due to HIV infection) or secondary (ie, due to opportunistic infections, neoplasms, or other conditions [peripheral]).
  • Opportunistic infections and neoplasms include toxoplasmosis, cryptococcosis, cytomegalovirus (CMV) infection, human T-cell leukemia virus type I infection, M tuberculosis infection, syphilis, progressive multifocal leukoencephalopathy, and primary CNS lymphoma. Secondary processes typically occur when CD4 cell counts are less than 200/µL.
  • Neurologic conditions that can occur during the acute HIV infection phase include aseptic meningitis, peripheral neuropathies (eg, mononeuritis multiplex, Guillain-Barré–like syndrome), and myopathy.
  • Aseptic meningitis can be observed in all but the very late stages of HIV infection. Patients may experience headache, photophobia, and frank encephalitis. Aseptic meningitis due to HIV infection usually resolves spontaneously within 2-4 weeks. Signs and symptoms may persist long-term in some patients.
  • Peripheral neuropathies are common in patients infected with HIV. They occur at all stages of illness and take various forms, as follows:
    • Acute inflammatory demyelinating polyneuropathy: Patients commonly present with progressive weakness, areflexia, and minimal sensory changes.
    • Mononeuritis multiplex: This is a necrotizing arteritis of peripheral nerves. Patients develop multifocal asymmetric cranial or peripheral nerve lesions, including facial or laryngeal palsy, wristdrop or footdrop, and other neuropathic symptoms.
    • Myopathy: This may range in severity from an asymptomatic creatine kinase elevation to a subacute syndrome characterized by proximal muscle weakness and myalgia.