AIDSWEEKLY Plus; Monday, September 10, 2001
Staff Medical Writers

NewsRx - Physicians with high-risk patients who present with symptoms of acute Epstein-Barr virus infection (or infectious mononucleosis) should consider a diagnosis of human immunodeficiency virus (HIV) infection, according to a clinical study published in the August 15, 2001, issue of the American Journal of Medicine.

HIV infected patients can display signs and symptoms that mimic acute Epstein-Barr virus infection or infectious mononucleosis, including fever, sore throat, swollen lymph nodes, lethargy, rash, muscle pain, and headache. Investigators determined that the Monospot, commonly used to test for Epstein-Barr infection or mononucleosis, can sometimes give a false-positive result in the setting of primary HIV infection.

Led by Drs. John A. Vidrih and Rochelle P. Walensky, a group of clinicians at the Massachusetts General Hospital, Boston Medical Center, Brigham and Women's Hospital, and the Harvard School of Public Health documented three cases in which false-positive Monospot tests during evaluation for nonspecific viral syndromes were later determined to be due to primary infection with HIV. The results of Epstein-Barr virus serology studies in each of these patients were consistent with chronic, but not acute, Epstein-Barr virus infection and HIV antibody tests were initially negative ("Positive Epstein-Barr virus heterophile antibody tests in patients with primary human immunodeficiency virus infection," Am J Med 2001 Aug 15;111(3):192-194.

Although false-positive testing has been associated with other viral illnesses, it had not been previously reported with primary HIV infection.

"Clinicians considering a diagnosis of infectious mononucleosis should discuss the patient's HIV risk behaviors and consider the diagnosis of primary HIV infection, which can be established with HIV RNA and antibody testing," recommended the authors. "Clinicians should also consider the possibility of HIV infection in high-risk patients who have had a diagnosis of infectious mononucleosis, especially if the diagnosis was based on a positive heterophile antibody test."

An accompanying editorial by Robert Geise, Janine Maenza, and Connie L. Celum, all of the Department of Medicine, University of Washington, underscores the significance of the findings reported by Vidrih, Walensky, and colleagues: a reminder of the challenges in recognizing primary HIV infection. The editorial advises physicians to take a sensitive yet thorough sexual and drug use history from patients at risk for HIV infection and cautions that, "Given the importance of early identification of HIV infection, heightened awareness of the diagnostic possibility is imperative. Acute HIV infection should be considered in the differential diagnosis of an unexplained viral syndrome in a sexually active adult."

This clinical study was supported by the U.S. Centers for Disease Control and Prevention and the U.S. National Institute of Allergy and Infectious Diseases.

This article was prepared by AIDS Weekly editors from staff and other reports.

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