Weintrob et al1 recently pointed out the infrequency in diagnosis of primary human immunodeficiency virus (HIV) infection by performing HIV RNA polymerase chain reaction (PCR) in patients who present with viral syndrome and have risk factors for HIV infection. However, they do not address cost-effectiveness of this strategy and the use of empirical antiretroviral therapy.
Fever, fatigue, myalgias, weight loss, headache, and nausea are nonspecific and common presenting symptoms in non–HIV-infected patients. The major risk factor for HIV transmission, an unprotected sexual intercourse, is also common. Because the cost of HIV RNA PCR testing is not insignificant,2 the authors should provide the total number of patients screened in the study. In addition, as they mentioned, initiation of antiretroviral therapy soon may reduce the long-lived, latently infected lymphocytes that act as a reservoir for HIV. I wonder if the authors initiate their screened patients on preemptive antiviral therapy until the test results become negative. Currently, the HIV RNA PCR test in many hospitals is a "send-out" test and takes several days to come back. Treatment history of the source patient is important to guide empirical antiretroviral selection because the regimens that are not part of the source patient's current treatment regimen may have a better chance of viral control.3