Volume 203 - Issue 3
Acute HIV infection presenting as erythema multiforme in a 45-year-old heterosexual man
Authors: Ian J Woolley and Tony M Korman
Med J Aust 2015; 203 (3): 137. || doi: 10.5694/mja15.00334
Published online: 3 August 2015
Published online: 3 August 2015
HIV infection is not only seen in men who have sex with men
To the Editor:
Ma and colleagues have provided an excellent description of an unusual presentation of HIV infection, erythema multiforme, in a heterosexual man.1 This “lesson from practice” comes in a long line of similar salutary cases published in the Journal, where we are reminded that HIV infection is not only seen in key populations — predominantly men who have sex with men (MSM) — in Australia. These have included the elderly,2 female returned travellers3 and heterosexual middle-aged men.1 In 2014, about 30% of new HIV infection diagnoses in Australia were not in individuals identified as MSM.4 In our cohort those who present late (with a low CD4 lymphocyte count) are less likely to self-identify as MSM.
Taking a sexual history is important and useful, but cannot be used to exclude the diagnosis of HIV infection — only HIV testing can. Other countries have moved to more generalised HIV testing strategies,5 in the context of a global goal of diagnosing 90% of those with HIV infection, but Australia still has a testing approach predominantly targeted at key populations. However, we can lower our threshold in the unwell, and test accordingly when the diagnosis is unclear. In 1993, the Journal published a very useful series that highlighted the myriad ways in which HIV infection can present. In 2015, we should continue to recall the title of this series and ask the question “Could it be HIV?” — if the answer is yes, then test!
Competing interests
No relevant disclosures.
References
- Ma JHY, Smith S, Gordon LA. Acute HIV infection presenting as erythema multiforme in a 45-year-old heterosexual man. Med J Aust 2015; 202: 273-274.
- Smibert OC, Ananda-Rajah M, O’Brien J, Visvanathan K. Age: HIV knows no boundary. Med J Aust 2014; 201: 481-482.
- Morrissey CO, Woolley IJ, Mijch A, et al. Febrile illness in a returned traveller: could it be primary HIV? Med J Aust 2001; 175: 172.
- The Kirby Institute. HIV in Australia: annual surveillance report 2014 supplement. http://kirby.unsw.edu.au/sites/default/files/hiv/resources/HIVASRsuppl2014_online.pdf (accessed Jul 2015).
- Moyer VA; US Preventive Services Task Force. Screening for HIV: US Preventive Services Task Force recommendation statement. Ann Intern Med 2013; 159: 51-60.