Question:

Hello,
I have 2 questions....
1. Can a 4th generation ELISA test(which also checks for p24 antigen) detect an ARS? Namely Abbot Axsym Ab/Ag.

To put it more precise, I have read in many articles that p24 antigen testing gives reactive results during ARS. Is it a special p24 test, or just the one that a 4th generation test includes? Two 4th generation tests were made on the second and seventh day of the symptoms with (-) result.

2. Can that be an ARS? : symptoms are sore thorat, mild fever, seriously runny nose..This lasted for 1 week, and after that 1 week of strange sort of mild muscle pain.

3. A reactive antibody result may be delayed up to 3-4 months. Is that also true for ARS? Or does ARS, if it happens, happen very early?

Thanks

Answer provided by:

Rodger MacArthur, M.D.
Wayne State University
Division of Infectious Diseases

Three components are necessary to confirm the diagnosis of the acute retroviral syndrome: 1) a compatible clinical syndrome; 2) detectable amounts of HIV RNA or p24 antigen; 3) a negative or indeterminate Western Blot antibody test. The latter is particularly important, because it takes several weeks after the first symptoms appear for the antibody test to turn positive. If the antibody test is positive at the time the symptoms are first noticed, then the individual is experiencing another clinical syndrome and has been infected with HIV at a previous point in time. In other words, the acute retroviral syndrome is a non-specific syndrome, with signs and symptoms that overlap other clinical syndromes (e.g., infectious mononucleosis).

The use of the RT PCR assay or the bDNA assay to detect HIV RNA is more sensitive than the assay for p24 antigen. In general, the former assays are preferred for the diagnosis of the acute retroviral syndrome, although a few more false positive results can occur than if the p24 antigen assay is used. False positive results typically occur from contamination of the assay from previous specimens. It is extremely unlikely that a result is a false positive if the HIV RNA level is >1000 copies/ml. The median level of HIV RNA at the time of diagnosis of the acute retroviral syndrome is >500,000 copies/ml. The p24 antigen typically is detectable only during the acute retroviral syndrome and late in the course of HIV infection.

Antibody to HIV can be detected as early as one month following exposure to HIV; by three months following exposure, approximately 95% of all those who ultimately seroconvert will test positive, and by 6 months following exposure approximately 100% of those who ultimately seroconvert will test positive.

Rhinorrhea and coryza (runny nose) are not symptoms commonly associated with the acute retroviral syndrome. Signs and symptoms often reported as part of the acute retroviral syndrome include: fever, which is invariably present and typically high; enlarged lymph nodes; rash; gastrointestinal manifestations; pharyngitis; headache; myalgias, and arthralgias; hepatomegaly and splenomegaly. Typically, these signs and symptoms develop two to six weeks after exposure to HIV in those individuals who ultimately go on to seroconvert from HIV-negative to HIV-positive. It is possible that the acute retroviral syndrome can occur as early as one week after exposure to HIV, but the average time is about three weeks after exposure. Symptoms last one to four weeks, and average two to three weeks in length. The acute retroviral syndrome is estimated to occur in up to 70% of those who ultimately seroconvert from HIV-negative to HIV-positive.

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