DrVirgo
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A 24-year-old man comes to the clinic complaining of
flu-like symptoms. For the past 10 days, he has had diffuse
myalgias, low-grade fevers, headache, and occasional
nausea and vomiting. He reports being generally
healthy in the past, though a review of his chart reveals
that he was treated for gonorrhea 4 weeks ago. Exam is
remarkable for a diffuse, tender lymphadenopathy as
well as two small, painful mucocutaneous ulcers in his
oropharynx. On further discussion with the patient, he
reveals that he has numerous HIV risk factors, including
intravenous drug use and sex with commercial sex
workers. Which of the following is the most appropriate
HIV test for this patient?
(A) CD4+ T-cell count
(B) ELISA for HIV antibody
(C) HIV RNA level
(D) P24 antigen serology
(E) Western blot
PLEASE EXPLAIN YOUR ANSWER. THANKS. 
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| MHP
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I think the answer is ELISA always is the first, doesn´t matter if you have or not risk factors, you must do first an ELISA
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| robin082006
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B
Screening test is ELISA
If Elisa positive, next step is Western Blot.
If Western Blot positive, do CD4 and PCR quantitative to determine management.
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| DrVirgo
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Thats what I thought as well, (Elisa to screen and WB to confirm), but here is the right answer...
The correct answer is C. This patient may have primary
HIV infection, which can present weeks to months after
exposure and presents as an acute viral illness. A high
degree of suspicion is needed to make the diagnosis,
inasmuch as the signs and symptoms are not specific.
Diffuse (as opposed to regional) lymphadenopathy is
present in 40 to 70% of patients. Mucocutaneous ulcers
are further suggestive of the diagnosis, as is the time
course of the illness. This primary infection correlates
with high degrees of viremia (so the appropriate test is to
determine the HIV RNA level), although the body may
not have had time to produce adequate amounts of antibodies
for traditional screening tests such as ELISA
(choice B) and the confirmatory Western blot (choice E).
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| DrVirgo
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So, in which type of cases would you say to do ELISA FIRST???
Someones gotta know the answer to this!!!! 
Edited by DrVirgo on 02/03/07 - 04:27 PM
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| DrVirgo
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Someone, anyone? 
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| CocaCola
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Antibodies for HIV may not show up for up to 6 months after infection... ELISA is great for screening asymptomatic patients in the latent period...
but if a patient comes with lymphadenopathy and flu-like symptoms with risky behavior this indicates recent (1-2 month) infections and Western Blot for antigen proteins may be a better choice of diagnosis...
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| dr_jojo
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Dr Virgo , can explain plz when we use HIV RNA LEVEL
what i know is ther are 3 stages for HIV
1.acute symptoms ...2.latent.....3.immunodeficiency
so u mean in acute symptom stage we use RNA for diagnosis insted of starting with ELISA THEN WESTERN
Could u explaine this point to me i will be thankful
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| DrVirgo
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Whenever you suspect primary infection which correlates
with high degrees of viremia, get an HIV RNA level.
For screening use Elisa. And to confirm: Western Blot.
-Thats what I got out of this question...
Can anyone go over when we would use PCR??? If I remember correctly, I think it's used to check for HIV in newborns of HIV + moms... Right? Anything else?
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| DrVirgo
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PCR:
Qualitative to detect HIV infection in newborns whose mothers are HIV+
Quantitative to determine viral load to asses treatment.
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