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Acute HIV Seroconversion — SCE Infectious Diseases MCQ

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EasyHIV MedicineAcute HIV SeroconversionSCE Infectious Diseases

A 33-year-old man is diagnosed with acute HIV seroconversion. His p24 antigen is strongly positive, HIV antibody is weakly reactive (evolving Western blot), and viral load is 8.5 million copies/mL. CD4 is 380 cells/µL. He presents with fever, pharyngitis, lymphadenopathy, and a maculopapular rash. When should ART be started?

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Correct answer: D — As soon as possible; do not delay for resistance testing results

BHIVA 2025 guidelines recommend starting ART as soon as possible in acute HIV infection, including during primary infection/seroconversion. Early ART limits viral reservoir establishment, preserves immune function, reduces transmission risk, and improves long-term outcomes (START and TEMPRANO trials). ART should not be delayed for resistance results — a regimen with a high genetic barrier to resistance (DTG-based) can be started empirically and modified if needed once results are available.

Reference: BHIVA 2025 – ART guidelines; START Trial 2015 – NEJM