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Acute HIV — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesAcute HIVRACP Adult Medicine

A 25-year-old man presents with a 2-week history of fever, pharyngitis, diffuse lymphadenopathy, and a maculopapular rash. He reports unprotected sexual intercourse 3 weeks ago. FBE shows lymphopenia. HIV p24 antigen is positive but HIV antibody is negative. What is the most likely diagnosis?

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Correct answer: E — Acute HIV seroconversion

Acute retroviral syndrome presents with a mononucleosis-like illness 2–4 weeks after HIV exposure. Lymphopenia (not lymphocytosis) distinguishes it from EBV. The window period means HIV antibody is negative but p24 antigen and HIV RNA are detectable. Fourth-generation Ag/Ab tests detect acute infection. Immediate ART initiation is recommended.

Reference: ASHM – 2024 – HIV Guidelines; Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine