Am Fam Physician. 2003 Jul 15;68(2):224.
to the editor: I would like to point out a minor, but potentially significant, error in the article “Lymphadenopathy and Malignancy”1 in American Family Physician. The authors appropriately include primary human immunodeficiency virus (HIV) infection in the differential diagnosis of lymphadenopathy. However, in Table 1they list “HIV antibody” as the diagnostic test of choice.
It has been reported that between 40 and 70 percent of patients experience diffuse lymphadenopathy following primary HIV infection. However, patients will not seroconvert until about 22 to 27 days postexposure.2 Thus, the standard HIV enzyme-linked immunosorbent assay (ELISA) will be negative if performed during the period of acute infection. The recommended test to obtain in this setting is an HIV RNA level by either polymerase chain reaction or branched DNA. Serologic testing for p24 antigen also may be used, but the reported sensitivity is only about 75 to 90 percent. In the majority of cases, the HIV RNA level will be exceedingly high (more than 100,000 copies per mL) and thus confirm the diagnosis. These patients can then be promptly referred for consideration of treatment with antiretroviral agents, concurrent with the current recommendations of the U.S. Public Health Service treatment guidelines.3Risk-reduction counseling also can be addressed during this time because there are epidemiologic studies suggesting that a significant amount of HIV transmission occurs from persons with early infection.4
1. Bazemore AW, Smucker DR. Lymphadenopathy and malignancy. Am Fam Physician. 2002;66:2103–10.
2. Kahn JO, Walker BD. Acute human immunodeficiency virus type 1 infection. N Engl J Med. 1998;339:33–9.
3. Dybul M, Fauci AS, Bartlett JG, Kaplan JE, Pau AK. Guidelines for using antiretroviral agents among HIV-infected adults and adolescents. Recommendations of the Panel on Clinical Practices for Treatment of HIV. MMWR Recomm Rep. 2002;51(RR-7):1–55.
4. Hecht FM, Busch MP, Rawal B, Webb M, Rosenberg E, Swanson M, et al. Use of laboratory tests and clinical symptoms for identification of primary HIV infection. AIDS. 2002;24:1119–29.
editor's note: A copy of this letter was sent to the authors of “Lymphadenopathy and Malignancy,” who declined to reply.
Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: firstname.lastname@example.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.
Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 2003 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions