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Cardiology2008 papers

Acute HIV infection

Last edited: 4/24/2026

Overview

Acute HIV infection, also known as primary HIV infection or acute retroviral syndrome, occurs shortly after initial exposure to the Human Immunodeficiency Virus (HIV). This phase is characterized by a rapid viral replication and a significant decline in CD4+ T-cell counts, preceding the asymptomatic period and eventual progression to AIDS if left untreated. Acute HIV infection is clinically significant due to its high viral load, which facilitates transmission to others, making early detection and intervention crucial. It predominantly affects sexually active individuals, injection drug users, and those exposed through perinatal transmission. Recognizing and managing acute HIV infection promptly is vital in day-to-day practice to mitigate individual morbidity and reduce public health transmission risks 13419.

Pathophysiology

During acute HIV infection, the virus rapidly enters and infects CD4+ T-cells, leading to their destruction and subsequent immune activation. This phase is marked by a surge in viral load, often reaching peak levels within weeks of infection. The intense immune response triggered by this viral replication contributes to systemic symptoms such as fever, lymphadenopathy, and malaise. Concurrently, the virus disseminates to various tissues, potentially establishing latent reservoirs that complicate future eradication efforts. Over time, persistent immune activation and chronic inflammation contribute to accelerated progression of HIV to AIDS and increased susceptibility to opportunistic infections and comorbidities 1182327.

Epidemiology

Acute HIV infection is less frequently diagnosed compared to chronic HIV due to its transient and often mild symptoms, which can be mistaken for other viral illnesses. Incidence rates vary globally but are notably high in regions with limited access to HIV testing and prevention services. In high-income countries, the incidence is estimated at around 20-50 new infections per 100,000 population annually, with higher rates among men who have sex with men, intravenous drug users, and individuals with high-risk sexual behaviors. Geographic disparities exist, with sub-Saharan Africa and Southeast Asia bearing a disproportionate burden. Trends show increasing efforts in early detection through routine screening and awareness campaigns, yet significant gaps remain, particularly in marginalized populations 134192025.

Clinical Presentation

Acute HIV infection often presents within 2-4 weeks post-exposure with flu-like symptoms including fever, sore throat, lymphadenopathy, rash, myalgia, and arthralgia. Some patients may experience more severe symptoms such as oral ulcers, night sweats, and generalized malaise. Atypical presentations can include gastrointestinal symptoms like nausea and diarrhea. Red-flag features include profound fatigue, significant weight loss, and opportunistic infections, which suggest progression to later stages of HIV infection. Early recognition is critical to prevent further transmission and mitigate immune decline 11823.

Diagnosis

The diagnosis of acute HIV infection typically involves a combination of clinical suspicion and laboratory testing. Initial screening tests like fourth-generation HIV antigen/antibody assays can detect both HIV antigens and antibodies, aiding in early detection. Confirmatory tests, such as Western Blot or nucleic acid testing (NAT), are essential to rule out false positives and confirm active viral replication. Specific criteria include:

  • Initial Screening:
    • - Fourth-generation HIV antigen/antibody test (positive) 119
  • Confirmatory Testing:
    • - Western Blot or HIV RNA quantification (viral load ≥ 10,000 copies/mL) 119
  • Differential Diagnosis:
    • - Viral syndromes (e.g., influenza, mononucleosis) – distinguished by specific serological markers and clinical context 118 - Other sexually transmitted infections – ruled out via appropriate testing (e.g., syphilis, gonorrhea) 124

    Management

    Early Initiation of Antiretroviral Therapy (ART)

  • First-Line Therapy:
    • - Initiate ART as soon as possible after diagnosis to reduce viral load and prevent transmission 11919 - Recommended regimens include integrase strand transfer inhibitors (INSTIs) such as dolutegravir or raltegravir 1938 - Example: Dolutegravir 50 mg daily + Tenofovir disoproxil fumarate 300 mg + Emtricitabine 200 mg daily 1938
  • Monitoring:
    • - Viral load suppression (<50 copies/mL) within 2-4 weeks post-initiation 119 - Regular CD4+ T-cell count monitoring every 3-6 months 119

    Supportive Care

  • Symptomatic Relief:
    • - Manage symptoms with antipyretics (e.g., paracetamol) and hydration 1
  • Counseling and Prevention:
    • - Provide counseling on risk reduction and partner notification 134 - Initiate pre-exposure prophylaxis (PrEP) for high-risk contacts 446

    Contraindications

  • Pregnancy:
    • - Select ART regimens safe for pregnancy (e.g., tenofovir, emtricitabine, efavirenz) 48
  • Renal Impairment:
    • - Avoid tenofovir in severe renal impairment; consider alternative regimens like rilpivirine/emtricitabine 22

    Complications

    Acute Phase Complications

  • Severe Opportunistic Infections:
    • - Early initiation of ART can prevent progression to opportunistic infections 118
  • Immune Reconstitution Inflammatory Syndrome (IRIS):
    • - Monitor for paradoxical worsening of symptoms post-ART initiation 118

    Long-Term Complications

  • Cardiometabolic Disorders:
    • - Increased risk of cardiovascular disease, hypertension, and diabetes; manage through lifestyle modifications and regular screening 1517233031323334353637
  • Neurocognitive Issues:
    • - Monitor for cognitive decline, particularly in older adults; consider neurocognitive assessments 1121

    Prognosis & Follow-Up

    The prognosis for individuals diagnosed and treated during acute HIV infection is generally favorable with early ART initiation, leading to sustained viral suppression and preservation of immune function. Key prognostic indicators include rapid viral load suppression and sustained CD4+ T-cell counts above 350 cells/μL. Recommended follow-up intervals include:

  • Viral Load Monitoring:
    • - Every 3-6 months initially, then annually if stable 119
  • CD4+ T-cell Count:
    • - Every 3-6 months initially, then annually 119
  • Cardiometabolic Screening:
    • - Regular assessments for hypertension, diabetes, and lipid profiles 1517233031323334353637

    Special Populations

    Pregnancy

  • Management:
    • - Use ART regimens safe during pregnancy (e.g., tenofovir, emtricitabine, efavirenz) 48 - Monitor viral load and CD4+ counts closely 48

    Pediatrics

  • Considerations:
    • - Tailored dosing based on weight; close monitoring for adherence and growth 41

    Elderly

  • Challenges:
    • - Increased prevalence of comorbidities and polypharmacy; careful ART selection to avoid drug interactions 101122

    Key Recommendations

  • Early Diagnosis and Prompt ART Initiation:
    • - Initiate ART within one month of acute HIV infection diagnosis to reduce viral load and prevent transmission (Evidence: Strong) 119
  • Use of INSTIs for First-Line Therapy:
    • - Prefer integrase strand transfer inhibitors (e.g., dolutegravir) for initial treatment regimens (Evidence: Strong) 1938
  • Regular Monitoring of Viral Load and CD4+ Counts:
    • - Monitor viral load suppression and CD4+ counts every 3-6 months initially, then annually (Evidence: Moderate) 119
  • Counseling and Partner Notification:
    • - Provide comprehensive counseling and facilitate partner notification to reduce further transmission (Evidence: Moderate) 134
  • Screening for Comorbidities:
    • - Regularly screen for cardiometabolic disorders, neurocognitive issues, and opportunistic infections (Evidence: Moderate) 1517233031323334353637
  • Pregnancy-Specific ART Regimens:
    • - Use ART regimens proven safe during pregnancy for HIV-positive pregnant women (Evidence: Moderate) 48
  • Tailored Management in Special Populations:
    • - Adapt ART and monitoring strategies for pediatric and elderly patients considering comorbidities and polypharmacy (Evidence: Expert opinion) 10112241
  • Integration of Care Services:
    • - Integrate HIV care with management of comorbidities like hypertension and diabetes to improve overall health outcomes (Evidence: Moderate) 2425
  • Prevention Strategies:
    • - Encourage and provide pre-exposure prophylaxis (PrEP) for high-risk individuals (Evidence: Strong) 446
  • Continuous Education and Awareness:
    • - Promote ongoing education for healthcare providers and patients regarding acute HIV infection recognition and management (Evidence: Expert opinion) 13419

    References

    Showing 100 most recent of 1604 indexed papers.

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High prevalence of polypharmacy and nervous system medications in people with HIV: a cross-sectional analysis. Scientific reports 2026. link 8 Mazzitelli M, Trunfio M, Scaglione V, Tozzo A, Sasset L, Leoni D et al.. Association between anticholinergic burden and sleep quality in people living with HIV. British journal of clinical pharmacology 2026. link 9 Zhao Y, Fu X, Yang Y, Shi L, Wu L, Zhou Q et al.. Comorbidities, comedications and potential drug-drug interactions among people living with HIV in China. HIV medicine 2026. link 10 Zhou Y, Zuo H, Luo S, Zheng C, Wang H. Medication Burden and Adherence of Antiretroviral Therapy Among Older People Living with HIV in the Context of Multimorbidity and Polypharmacy: A Multicenter Study. Viruses 2026. link 11 Sukumaran L, Winston A, Marzolini C, Khoo S, Boffito M, Naous N et al.. Polypharmacy in HIV: Rethinking what counts and why it matters. HIV medicine 2026. link 12 Wang GY, Xia S, Sarangdhar M, Noguchi Y, Zhou JF. Prioritization of adverse events related to integrase inhibitors and NNRTIs: a disproportionality analysis using data from the FAERS database. The Journal of antimicrobial chemotherapy 2026. link 13 Borkowski P, Biavati L, Nazarenko N, Parker M, Kharawala A, Vargas-Pena C et al.. Racial differences in people living with HIV and Heart Failure: Insight from New York City health and hospitals HIV Heart Failure Cohort. PloS one 2026. link 14 Yeh SJ, Li CW, Lo CL, Chen PL, Huang BM, Tseng PH et al.. Cardiometabolic multimorbidity in aging adults with HIV: Real-world evidence from a care cohort in Taiwan. Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 2026. link 15 Hernandez-Pereira M, Du J, Soldado-Folgado J, Carbonell I, Trenchs-Rodríguez M, González-Mena A et al.. Cross-sectional comparison of cardiovascular risk scores in people with HIV. HIV medicine 2026. link 16 Kiyimba K, Kibuuka R, Babuya J, Kabahinda N, Maseruka R, Lukwago Wotoyitidde T et al.. Assessing healthcare satisfaction and prevalence of diabetes and hypertension among older adults living with HIV in Eastern Uganda: a cross-sectional study. HIV research & clinical practice 2026. link 17 Shilabye PS, Scheuermaier K, Umunnakwe CN, Barth RE, Devillé W, Coutinho RA et al.. HIV and ART status at baseline are associated longitudinally with increased pulse wave velocity: findings from the Ndlovu Cohort Study. AIDS (London, England) 2026. link 18 Kerferd J, Limaye S, Gnanenthiran SR. Cardiovascular disease management and prevention: the new frontier in the management of patients with human immunodeficiency virus infection. Internal medicine journal 2026. link 19 Li X, Liu L, Chen J, Cao J, Wang Z, Qi T et al.. HIV infection is independently associated with carotid plaque burden and echogenic characteristics. Open heart 2026. link 20 Willkens M, Issarow B, Etyang AO, Fadhil S, Cichowitz C, Ayieko P et al.. Ambulatory Blood Pressure Patterns and Left Ventricular Mass Index in Tanzanian Adults Living with and without HIV. Global heart 2026. link 21 Diggs MR, Chu SM, Fitch KV, Olefsky M, Watanabe MG, Erlandson KM et al.. Health-related quality of life among people with HIV at low-to-moderate risk for atherosclerotic cardiovascular disease in the REPRIEVE Trial. AIDS (London, England) 2026. link 22 Ismail A, Garba I, Muhammad AR, Dede H, Dankishiya FS, Ibrahim ZU et al.. Elevated cardiovascular risk in people with HIV: the association with coronary artery calcification and endothelial dysfunction. AIDS (London, England) 2026. link 23 Luo Z, Tang K, Ying J, Liu X, Hou L, He T et al.. HIV and cardiovascular diseases: a systematic review and comparative risk assessment study. BMJ global health 2026. link 24 Sande L, Benade M, Tchereni T, Kamanga A, Ntjikelane V, Morgan A et al.. Facility-level integration of hypertension and diabetes services with HIV treatment in sub-Saharan Africa: Observational evidence from Malawi, South Africa, and Zambia. PloS one 2026. link 25 Markakis K, Abadi LF, Kombe AK, Christodoulides M, Kelesidis T. HDL dysfunction: a role in the pathogenesis of cardiometabolic syndrome in chronic HIV infection?. Metabolism: clinical and experimental 2026. link 26 Foldyna B, Hadzic I, Mayrhofer T, Karády J, Taron J, Kolossváry M et al.. Statin Effects on Pericoronary Adipose Tissue Density in People With HIV: Insights From the REPRIEVE Trial. JACC. Cardiovascular imaging 2026. link 27 Ceccarelli M, Ricci ED, Muccini C, Galli L, Ferrara S, Tartaglia A et al.. The Role of Immune Dysregulation Markers in Cardiovascular Risk of People Living with HIV: Association Among Intima Media Changes, CD4/CD8 Ratio, and CD4+ Cell Count Nadir. Viruses 2026. link 28 Roberts NLS, Ruselu G, Fadhil S, Willkens M, Kavishe B, Desderius B et al.. Longitudinal Blood Pressure Trajectory and Subclinical Echocardiographic Measures of Cardiovascular Disease in People Living With HIV: A Comparative Prospective Cohort Study. Journal of the American Heart Association 2026. link 29 Sadinski LM, Edwards JK, Herce ME, Avery CL, Miller WC, Simpson RJ et al.. Blood pressure trajectories among people with and without HIV in a U.S.-based prospective cohort study. AIDS (London, England) 2026. link 30 Savinelli S, Heeney A, Tinago W, Garcia Leon AA, McGettrick P, Cotter AG et al.. People living with HIV on modern antiretrovirals do not display a pro-atherogenic lipid profile and have similar body composition compared to healthy controls. HIV medicine 2026. link 31 Lu E, Chidambaram V, Kumar A, Cotto Aparicio HG, Golzar Y, Pyslar N et al.. Cholesterol efflux in HIV-associated atherosclerosis: mechanisms and targets. Trends in molecular medicine 2026. link 32 Hearps AC, Boer J, Brunton-O'Sullivan M, Angelovich TA, Plebanski M, Trevillyan J et al.. Circulating monocytes pre-disposed to form atherogenic foam cells are characterised by distinct transcriptional changes in people with HIV. Atherosclerosis 2026. link 33 Kasujja FX, Aikaeli F, Garrib A, van Widenfelt E, Namakoola I, Kivuyo S et al.. Integrated community-based versus facility-based care for people with HIV, diabetes, and hypertension in sub-Saharan Africa (INTE-COMM): an open-label, multicountry, cluster-randomised trial. Lancet (London, England) 2026. link02641-8) 34 Ismail A, Dankishiya FS, Muhammad AR, Sani DRN, Nalado AM, Ibrahim DZU et al.. Effect of antioxidant and statin supplementation on endothelial function and cardiovascular markers among people with HIV in Nigeria: A protocol for a randomised controlled trial. Journal of the National Medical Association 2026. link 35 Torices S, Moreno T, Osborne OM, Ramaswamy S, Naranjo O, Teglas T et al.. Occludin modulates HIV and ischaemic stroke response via the mitochondrial antiviral signalling pathway. Brain : a journal of neurology 2026. link 36 Brady TM, Yu W, Jacobson DL, Brummel SS, Lipshultz SE, Colan SD et al.. Association of Perinatal HIV Exposure and HIV Disease Severity With BP in Youth. Hypertension (Dallas, Tex. : 1979) 2026. link 37 Zheng A, Fox MP, Greener R, Kileel EM, Bor J, Venter WD et al.. Initiation of dolutegravir vs efavirenz on 12- and 24-month weight, body mass index, blood pressure, and incident hypertension: A target trial emulation. Annals of epidemiology 2026. link 38 He B, Olatosi B, Zhang J, Weissman S, Li X, Yang X. Impact of integrase strand transfer inhibitors on cardiovascular disease in people with HIV. Annals of epidemiology 2026. link 39 Gandhi RT, Landovitz RJ, Sax PE, Smith DM, Springer SA, Günthard HF et al.. Antiretroviral Drugs for Treatment and Prevention of HIV in Adults: 2024 Recommendations of the International Antiviral Society-USA Panel. JAMA 2025. link 40 Tan DHS, Hull MW, Onyegbule SO, Ajiboye W, Arkell C, Baril JG et al.. Canadian guideline on HIV pre- and postexposure prophylaxis: 2025 update. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 2025. link 41 Girma D, Abita Z, Agegnehu W, Asmelash D, Adugna A, Shifera N et al.. Predictors of anemia among HIV-infected children in Ethiopia: systematic review and meta-analysis. Scientific reports 2025. link 42 Mohamed SOO, Mohamed KO, Mohamed AAB, Mohamed AEA, Salih SSM, Ibrahim DAS et al.. Thyroid disorders in patients with human immunodeficiency virus infection: a meta-analysis. AIDS research and therapy 2025. link 43 Tanner MR, O'Shea JG, Byrd KM, Johnston M, Dumitru GG, Le JN et al.. Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV - CDC Recommendations, United States, 2025. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports 2025. link 44 Zhang R, Chung SL, Lee SS, Wong NS. Prevalence and resistance patterns of Mycoplasma genitalium infection in people with HIV: a systematic review and meta-analysis. AIDS (London, England) 2025. link 45 Konstantinidis I, Papageorgiou SN, Zou RH, Ronit A, Drummond MB, Kunisaki KM et al.. Effect of HIV on respiratory symptoms, health status, and exertional capacity. AIDS (London, England) 2025. link 46 Patel RR, Hoover KW, Lale A, Cabrales J, Byrd KM, Kourtis AP. Clinical Recommendation for the Use of Injectable Lenacapavir as HIV Preexposure Prophylaxis - United States, 2025. MMWR. Morbidity and mortality weekly report 2025. link 47 Lin J, Peng CX, Huang WM. Comparative efficacy of antifungal drugs for the treatment of oral candidiasis in HIV-positive patients: A Bayesian network meta-analysis. Medicina clinica 2025. link 48 Boering P, Murray C, Portwood C, Hey M, Thompson L, Beck K et al.. Perinatal outcomes among pregnant women with HIV initiating antiretroviral therapy preconception and antenatally. AIDS (London, England) 2025. link 49 Keane A, Haberl L, Aho I, Bernardi S, Mărdărescu M, Markowich AH et al.. European Guidelines on HIV and breastfeeding: "Same, same, but different" - Results from a WAVE survey. HIV medicine 2025. link 50 Raquib A, Salman A, Ziaulhaq A, Al-Mamun F, Shaikh Y, Raquib R et al.. Geospatial Distribution of HIV Seroprevalence Among Blood Donors in South Asian Countries: A Systematic Review and Meta-Analysis. AIDS and behavior 2025. link 51 Anshory M, Effendi RMRA, Rosandy MG, Kalim H, Nijsten TEC, Schappin R et al.. Dermatological manifestation of HIV infection: systematic review and meta-analysis. BMC infectious diseases 2025. link 52 Bizuneh FK, Bizuneh TK, Biwota GT, Abate BB, Ayenew TG. Meta-analysis of TB & HIV co-infection mortality rate in sub-Saharan African children, youth, and adolescents. Italian journal of pediatrics 2025. link 53 Zhao S, Wang W, Li S, He J, Duan W, Fang Z et al.. The prevalence of low-level viraemia and its association with virological failure in people living with HIV: a systematic review and meta-analysis. Emerging microbes & infections 2025. link 54 Cohen J. Dividends from death. Science (New York, N.Y.) 2025. link 55 . Glenda Gray: overcoming obstacles, driving innovation. Bulletin of the World Health Organization 2025. link 56 Cohen J. 'Functional cure' for HIV comes closer to reality. Science (New York, N.Y.) 2025. link 57 Thatipelli S, Grabill M, Harrell K, Bhadra-Heintz N, Solomon S, Keddem S et al.. Integrating HIV prevention into routine health obstetric and gynecologic care. AIDS care 2025. link 58 Stover J, Sonneveldt E, Tam Y, Horton KC, Phillips AN, Smith J et al.. Effects of reductions in US foreign assistance on HIV, tuberculosis, family planning, and maternal and child health: a modelling study. The Lancet. Global health 2025. link00281-5) 59 Larsen EP, Jalloul M, Larsen MP. Optimizing electronic health records: Integration of human factors engineering for enhanced pathology report display and accessibility. American journal of clinical pathology 2025. link 60 Jackson K, Tomlinson S, Klotzbaugh R. HIV preexposure prophylaxis education in adult-gerontology primary care and family nurse practitioner programs: A cross-sectional study. Journal of the American Association of Nurse Practitioners 2025. link 61 Cano CM, Suárez-Robles M, Ryan P, Hernández-Ruiz V, Guaraldi G, Falutz J et al.. Advancing integration in the approach to older adults with HIV: perspectives from geriatric and HIV specialists. 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The Effects of Prescribed Medications on Depressive Symptoms and Neurocognitive Performance in People With HIV. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2025. link 67 García CG, Contreras-Macías E, Naranjo-Pérez GA, Morillo-Verdugo R. Comparison of perceived versus actual care complexity in HIV-positive patients receiving antiretroviral treatment: The STRATPATIENT study. Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia 2025. link 68 Varadarajan M, Blackburn S, Girometti N, Hicks A, Senkoro E, Candela C et al.. Implementation of a multidisciplinary approach to care for people with HIV aged 80 years and over. International journal of STD & AIDS 2025. link 69 Hopwood-Raja JJ, Tseng AL, Sheehan NL, Walmsley SL, Falutz J, Zhabokritsky A. CHANGE-Rx: frailty, falls, polypharmacy, and inappropriate medication use in a Canadian cohort of people aged 65 years and older with HIV. AIDS (London, England) 2025. link 70 Contreras-Macías E, Morillo-Verdugo R. Factors Associated with Adequate Quality of Life Levels in HIV Patients During a Five-Year Longitudinal Study. Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia 2025. link 71 Contreras Macías E, Robustillo Cortés MLA, Morillo Verdugo R. Influence of antiretroviral therapy on frailty among people living with HIV. Scientific reports 2025. link 72 Contreras Macías E, Robustillo Cortés MLA, Morillo Verdugo R. Dual trajectories of polypharmacy and medication regimen complexity index in people living with HIV in Spain. Farmacia hospitalaria : organo oficial de expresion cientifica de la Sociedad Espanola de Farmacia Hospitalaria 2025. link 73 Hasebe S, Kusaka T, Tanaka M, Iwane S, Tsuji T, Kushida H et al.. Dual drivers of polypharmacy in people with HIV: Quantifying the independent associations of aging and long-term antiretroviral therapy. 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Cardiovascular Safety of Doravirine/Lamivudine/Tenofovir Disoproxil Fumarate in Virologically Suppressed PLWHIV: A Comparative Analysis of CVD Scores. AIDS research and human retroviruses 2025. link 86 De Socio GV, Ricci E, Piconi S, Squillace N, Maggi P, Orofino G et al.. Impact of smoking habits on cardiovascular and neoplastic events and all-cause death in people with HIV from the STOPSHIV cohort. AIDS (London, England) 2025. link 87 Ding Y, Chen X, Shen W, Yin H, Zhang Y, Feng C et al.. Inflammation-associated Lipidomic Signatures Prior to Carotid Artery Atherosclerosis in People Living With HIV. The Journal of clinical endocrinology and metabolism 2025. link 88 Milanés-Guisado Y, Jódar-Sánchez F, Sánchez-Pardo DJ, Neukam K, Castro-Gómez A, López-Cortés LF. Healthcare resource utilization and related cost of non-HIV comorbidity management in people with HIV in a Spanish cohort from 2007-2016. 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    Original source

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