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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 presents with fever, cervical lymphadenopathy, pharyngitis, and a maculopapular rash after sexual contact 3 weeks ago. HIV antibody test is negative. What is the most appropriate investigation?

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Correct answer: EHIV RNA viral load (PCR)

Acute HIV seroconversion illness presents 2–6 weeks after infection with a glandular fever-like syndrome (fever, pharyngitis, lymphadenopathy, rash). Standard antibody tests may be negative during the 'window period'. Fourth-generation combination antigen/antibody tests detect p24 antigen early, but HIV RNA PCR (viral load) is the most sensitive test during acute infection, typically positive within 10–14 days. Early diagnosis is critical for public health (very high viral load during seroconversion) and for commencing ART.

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