Abstract
BackgroundThe highest incidence of human immunodeficiency virus infection in China is among men who have sex with men. This case report aims to describe the dynamic changes in biomarkers in an acute human immunodeficiency virus infection of a Han Chinese man who has sex with men, and to illustrate the possibility of using these biomarkers for the early detection of human immunodeficiency virus infection in Chinese hospital settings.Case presentationThe 25-year-old Han Chinese male patient presented himself with an 8-day history of symptoms and signs of upper respiratory viral infections to a sexually transmitted infection clinic of a hospital setting in Shanghai. The viral load of human immunodeficiency virus, p24 antigen–antibody complex, and lymphocyte subsets of blood samples were repeatedly measured over the next 39 days. The human immunodeficiency virus from serum was genotyped. This patient was diagnosed as a human immunodeficiency virus infection, and the viral genotype was CRF 01_AE. The onset of the symptoms and signs was 12 days after his last reported unprotected intercourse with a human immunodeficiency virus -infected man. The patient had detectable levels of p24 antigen at his first visit, 20 days after infection, and the HIV viral load was at the highest point (8 × 106 copies/ml). A low concentration of antibody to HIV was observed in the patient’s serum 10 days after his 1st visit (30 days after infection). The confirmation of human immunodeficiency virus infection by Western blot assays was made at day 20 after his 1st visit (40 days after infection).ConclusionsSymptoms of acute human immunodeficiency virus infection are non-specific. Specific laboratory markers appear shortly after HIV infections. The first biomarker detected from serum is the viral RNA and p24 antigen, followed by HIV-specific antibody. The results suggest that there are urgent needs for both human immunodeficiency virus antigen and antibody testing in routine medical practice, and that human immunodeficiency virus RNA testing should be recommended to detect early infection. Ethics approval was obtained from the Ethics Board of the Shanghai Dermatology Hospital.
Highlights
The highest incidence of human immunodeficiency virus infection in China is among men who have sex with men
The first biomarker detected from serum is the viral RNA and p24 antigen, followed by human immunodeficiency virus (HIV)-specific antibody
The results suggest that there are urgent needs for both human immunodeficiency virus antigen and antibody testing in routine medical practice, and that human immunodeficiency virus RNA testing should be recommended to detect early infection
Summary
The reported case is an acute HIV-CRF 01_AE infection in a Han Chinese male patient who had unprotected sex with a HIV infected man. Most HIV screening tests in Chinese clinical settings detect antibodies but not viral antigen proteins or RNA [12, 13]. Combined viral antigen and specific antibody may still miss HIV infections in acute stages (i.e. within 20 days after HIV acquisition) [4, 12]. This study suggests that detection of HIV virus RNA and HIV-p24 antigen in the serum are required for early diagnosis of HIV infections and recommends an urgent need for antigen–antibody combination-based HIV tests in clinical settings. Availability of data and materials Data and materials are stored in the Shanghai Dermatology Hospital electroni‐ cally and in a hard copy format. The funding agencies had no role in the design or execution of the study, nor in the interpretation or publication of its results
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