Acute HIV infection in a critically III 15-year-old male

Nadia Dowshen, Virginia M. Pierce, Allison Zanno, Nicole Salazar-Austin, Carol Ford, Richard L. Hodinka

Research output: Contribution to journalArticle

Abstract

A 15-year-old previously healthy male presented with fever, vomiting, diarrhea, malaise, and altered mental status. In the emergency department, the patient appeared acutely ill, was febrile, tachycardic, hypotensive, and slow to respond to commands. He was quickly transferred to the ICU where initial evaluation revealed elevated white blood cell count and inflammatory markers, coagulopathy, abnormal liver function, and renal failure. Head computed tomography, cerebrospinal fluid studies, and blood cultures were negative. He was quickly stabilized with intravenous fluids and broad-spectrum antibiotics. When his mental status improved, the patient consented to HIV testing and was found to be negative using laboratory-based and rapid thirdgeneration HIV type 1 (HIV-1)/HIV type 2 antibody assays. The specimen was subsequently shown to be positive for HIV by a newly licensed fourth-generation antigen/antibody test. HIV-1 Western blot performed on this sample was negative, but molecular testing for HIV-1 RNA 4 days later was positive and confirmed the screening result. The patient was later determined to have a viral load of 5 624 053 copies/mL and subsequently admitted to unprotected receptive anal intercourse 2 weeks before admission. This case demonstrates an atypically severe presentation of acute HIV infection with important lessons for pediatricians. It highlights the need to consider acute HIV infection in the differential diagnosis of the critically ill adolescent and for appropriate testing if acute infection is suspected. This case also illustrates the shortcomings of testing adolescents based only on reported risk and supports Centers for Disease Control and Prevention and American Academy of Pediatrics recommendations for routine testing.

Original languageEnglish (US)
Pages (from-to)e959-e963
JournalPediatrics
Volume131
Issue number3
DOIs
StatePublished - Mar 2013
Externally publishedYes

Keywords

  • Adolescent medicine
  • Adolescent sexual behavior
  • Adolescent sexual health
  • Critically ill children
  • Hiv
  • Hiv primary infection
  • Hiv symptoms

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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  • Cite this

    Dowshen, N., Pierce, V. M., Zanno, A., Salazar-Austin, N., Ford, C., & Hodinka, R. L. (2013). Acute HIV infection in a critically III 15-year-old male. Pediatrics, 131(3), e959-e963. https://doi.org/10.1542/peds.2012-1533