Clinical Communications: Adult ACUTE HIV INFECTION IN A PATIENT WITH REPEAT HIV ANTIBODY/ANTIGEN NEGATIVE RESULTS PRESENTING AT AN URBAN EMERGENCY DEPARTMENT: A CASE REPORT Jason Wilson, MA, MD,*† Geetha Sanmugalingham, MSC,*† Oluwatobi Ozoya, MD, MPH,*† Larissa Pierce, MA, MD,‡ Kelsey Hundley, MS, MD,* and Sri Harsha Palakurty, BS* *Department of Internal Medicine, University of South Florida, Tampa, Florida, †Department of Emergency Medicine, TeamHealth/Tampa General Hospital, Tampa, Florida, and ‡Department of Family and Community Medicine, University of Alabama at Birmingham, Birmingham, Alabama Reprint Address: Jason Wilson, MA, MD, Department of Emergency Medicine, TeamHealth/Tampa General Hospital, 1 Davis Blvd., Suite 503, Tampa, FL 33606 , Abstract—Background: It is not uncommon for patients with human immunodeficiency virus (HIV) infections to visit the emergency department (ED) during seroconver- sion. However, patients with newly acquired HIV may not have a reactive screening result. We report a case of a patient who initially screened reactive on a fourth generation HIV test and subsequently nonreactive twice, but ultimately had positive viral load tests. Case Report: A 41-year-old woman experiencing symptoms of a sore throat, odynopha- gia, and back and flank pain for 5 days presented to the ED. The patient had a reactive HIV screen but negative confir- matory antibody test. The ED provider ordered a HIV viral load, informed the patient, and discharged with oral anti- bacterial agent. The patient returned the next day and after review of Visit 1 results, the ED provider ordered a second HIV screen, which had a nonreactive result. Another HIV viral load order was placed. The patient was discharged and returned a third time, 4 days after initial presentation. On this visit she was admitted, and the initial HIV viral load result returned positive. Why Should an Emergency Physician Be Aware of This?: We report a case of a patient who initially screened reactive on a fourth generation HIV screening and then twice nonreactive on the same screening test, ultimately having positive viral loads. The most prob- able explanation for her series of atypical HIV results is that the patient presented during the p24 seroconversion window, which is graphically conveyed in Figure 1. If her first screening had been performed during the window, no further test would have been performed to rule out HIV, contributing to misdiagnosis. ED providers need to be aware that, at some time points during seroconversion from ‘‘nega- tive’’ to ‘‘positive’’, patients recently infected with HIVand manifesting prodromal symptoms may nonetheless have a negative screening result. Ó 2019 Elsevier Inc. All rights reserved. , Keywords—HIV seroconversion; negative HIV Ab/Ag screen; second p24 window INTRODUCTION The 2006 Centers for Disease Control and Prevention (CDC) recommendation for routine human immunodefi- ciency virus (HIV) screening had been implemented by only 19% of emergency departments (EDs) surveyed in 2011 (1). However, high-risk patients’ first point of entry into the health care system for assessment during the Meeting: Presented as a poster at Florida Chapter Division of the American Academy of Emergency Medicine (FLAAEM) annual Scientific Assembly April 22–23, 2017, Miami Beach, FL. RECEIVED: 25 April 2018; FINAL SUBMISSION RECEIVED: 30 April 2019; ACCEPTED: 22 June 2019 e113 The Journal of Emergency Medicine, Vol. 57, No. 4, pp. e113–e116, 2019 Ó 2019 Elsevier Inc. All rights reserved. 0736-4679/$ - see front matter https://doi.org/10.1016/j.jemermed.2019.06.032