Almost 20 years into the epidemic, HIV disease has unquestionably moved out of the domain of the generalist, and become the nearly exclusive province of the HIV specialist. The latter are generally, although not always, infectious disease specialists. In spite of this, military primary care physicians, including GMOs, will provide some care to patients with established HIV infection. Perhaps more importantly, primary care providers will serve as the initial (and often only) point of contact with the health care system for infected individuals in the process of seroconverting.

Detection of patients in the process of seroconverting (i.e. with acute HIV illness) is woefully inadequate in all settings, military and civilian; however, it is a potentially very valuable contribution to the care of these individuals when it occurs. Up to two-thirds of patients newly infected with HIV will have manifestations of acute infection, generally referred to as seroconverting illness. Oftentimes this takes the form of an infectious mono-like illness or "flu." Common symptoms include fever, sore throat, a maculopapular rash, generalized lymphadenopathy, fatigue, malaise, myalgias, oral ulcerations, and less commonly an aseptic meningitis. Occasionally, more impressive manifestations such as thrush, shingles, or even full-blown opportunistic infections may occur; although these are certainly the exception rather than the rule. While the first group of symptoms is admittedly nonspecific, any combination of them should suggest the possibility of HIV seroconversion. This is particularly true if symptoms last for a week or longer, as illness associated with acute HIV infection generally lasts from one to several weeks. Current thought is that detection of illness at this stage followed by aggressive treatment will likely, favorably alter the course of the disease, by lowering the viral "setpoint" that develops over the first 6 months or so of infection.

As already mentioned, detection of infection at this early stage is highly desirable. Unfortunately, the majority of the time serology for HIV will still be negative during this period, and so testing with a surrogate is important. Historically, testing has been done by checking a p24 antigen and this has now been largely supplanted by an HIV viral load evaluation. The latter is a highly sensitive and specific test, as viremia is generally very high during acute infection. If one of these tests cannot be obtained (i.e. deployment), it is important to check HIV serology shortly after the acute infection, along with a viral load if possible. A patient found to be seroconverting should be discussed urgently with an infectious disease specialist, and if possible referred acutely.