Never too early for the opportunists!

Abstract

Primary HIV infection can occur in 40-90% of individuals recently infected with HIV. Variable symptoms usually suggestive of a flu-like illness as well as high-level HIV viraemia and steep decline in CD4 cell count are often noted. We report a case of a previously healthy homosexual man who presented with symptoms suspicious of primary HIV infection as well as non-productive cough associated with chest CT finding of diffuse ground glass appearance in lungs. Recent HIV seroconversion was confirmed. Diagnosis of Pneumocystis jirovecii pneumonia was made on transbronchial lung biopsy. The symptoms improved rapidly after initiation of treatment with trimethoprim-sulfamethoxazole. It is important to recognise that although Pneumocystis pneumonia is generally seen in the setting of AIDS, it can occasionally also occur during primary HIV infection.

Development of a multiassay algorithm (MAA) to identify recent HIV infection in newly diagnosed individuals in Indonesia

“… 62 , 63 Alternatively, they may represent latent TB that was activated by immunocompromised conditions of acute HIV infection, which explains the biomarker evidence of recent HIV infection. 20 , 21 Overall, the clinical information and the biomedical evidence from MAA were in agreement that ten individuals fulfilled the prerequisites defining HIV infection in the period of 12 months after seroconversion, or recent infection.…”

“…Our MAA employed samples from Indonesia where many newly diagnosed individuals present late in infection and often accompanied with disease symptoms. 58 , 59 CD4 + lymphopenia was observed in three individuals (2–1708, 2–1902, and 2–0507) and is not uncommon in PHI, as have been described in individuals with OIs 20 , 21 or in individuals infected by the highly virulent variant. 60 Two PLWH with biomarker evidence of recent HIV infection (2–0903 and 2–1517) had active TB infection.…”

“… 32 Decreases of CD4 + T cell count to ≤200 cells/μL within the first year of HIV infection are rare, although it may occur in those accompanied by opportunistic infections. 20 , 21 Prior longitudinal studies of HIV infection revealed a low frequency (0.2%) of individuals with CD4 ≤200 cells/μL within the first year of HIV infection,. 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 For an MAA, reducing the FLTR at the beginning is critical and early placement of CD4 + T cell count 200 cells/μL effectively excludes most (99.8%) of chronic infections, while less likely to eliminate true recent infection.…”

“…The ultimate evidence of recency remains seroconversion date and in circumstances where documented seroconversion is not available, assessment of medical records and clinical manifestation at the time samples are collected can avoid misclassification. 20 , 21 …”

Case Report: Leishmania and HIV Co-Diagnosis: How to Understand Medical History?

“…Furthermore, in infected cells, leishmaniasis is responsible for an overexpression of CCR5, a coreceptor necessary to HIV entry into T-cells, promoting increased viral load and disease progression towards AIDS (14). We know that opportunistic infections can occur during the early stages of HIV infection as Pneumocystis pneumonia, Candida esophagitis, toxoplasmosis or cryptococcal meningitis have been described during primary HIV infection (15).…”