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General Medicine · Infectious diseases: acute HIV infection
Sample itemA man has fever, sore throat, maculopapular rash and cervical lymphadenopathy 3 weeks after unprotected sex. A rapid HIV antibody test is negative. Which test should be done next?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. HIV-1 RNA PCR or fourth-generation antigen-antibody assay
In the acute retroviral syndrome the antibody test may still be negative, but viral RNA and p24 antigen are detectable. A viral load or fourth-generation combination assay closes the window period.
Option by option
A. HIV-1 RNA PCR or fourth-generation antigen-antibody assay (correct)
Correct. Viral RNA or p24 antigen appears before antibodies.
B. Repeat the antibody test only after 12 months
Waiting a year delays diagnosis and treatment and allows spread.
C. Western blot
Western blot detects antibodies and is also negative in the window period.
D. CD4 count alone
CD4 count is not diagnostic and may be normal early.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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