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Acute HIV Seroconversion — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesAcute HIV SeroconversionRACP Adult Medicine

A 30-year-old man from a high-risk group presents with a mononucleosis-like syndrome: fever, pharyngitis, lymphadenopathy, maculopapular rash (trunk and palms), and oral ulcers. Monospot is negative. He reports unprotected sexual intercourse 3 weeks ago. FBE shows lymphopenia. What test should be urgently requested?

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Correct answer: D — Acute HIV seroconversion

Mononucleosis-like illness with NEGATIVE monospot, rash involving palms, oral ulcers, lymphopenia, and high-risk sexual exposure 2-4 weeks prior is acute HIV seroconversion (primary HIV infection). Request HIV-1/2 antibody/antigen combination test (4th generation — detects p24 antigen before antibodies). HIV RNA viral load confirms if antibody test equivocal. Early diagnosis is critical: acute HIV has high viral load and high transmission risk. Start ART as soon as diagnosis confirmed.

Reference: ASHM – 2024 – HIV Testing; eTG Antibiotic 2025