Utility of an HIV-1 RNA assay in the diagnosis of acute retroviral syndrome

Highly active antiretroviral therapy (HAART) begun during primary infection with human immunodeficiency virus type 1 (HIV-1) can preserve immune function and may alter the long-term clinical course of HIV-1 infection. To diagnose primary HIV-1 infection (PHI) early, when screening serologies may yield negative or indeterminate results, the Department of Health and Human Services recommends the use of an HIV-1 RNA assay for at-risk patients suspected of having acute retroviral syndrome (ARS). Because of the RNA assay's 1.9% to 3.0% false-positive rate, results must be carefully interpreted and compared to HIV-1 viral load levels seen during proven HIV-1 seroconversion. We report the case of a sexually active woman with symptoms suggestive of ARS who had a false-positive HIV-1 RNA assay result. We discuss use and interpretation of the HIV-1 RNA assay in diagnosing PHI.