21 Feb Signs and Symptoms of Acute Retroviral Infection May Improve Early HIV Detection
MedicalResearch.com Interview with:
Martin Hoenigl, MD
AntiViral Research Center, Department of Medicine
University of California, San Diego
Medical Research: What is the background for this study?
Response: The detection of acute HIV infection (AHI) is critical to HIV prevention and treatment strategies. Many field-based testing programs rely on point-of-care HIV antibody testing, which will reliably identify persons with established infection, but fail to detect persons with AHI. In many of these programs additional tests for AHI are only performed / recommended in persons presenting with signs and symptoms consistent with an acute retroviral syndrome (ARS). These signs and symptoms are unspecific and include fatigue, headache, pharyngitis, skin rash, GI symptoms, night sweats and others. However, the proportion of persons with acute HIV infection presenting symptomatic for their diagnostic test remains unknown.
The objective of our study was therefore to determine the proportion of persons with acute HIV infection presenting with signs and symptoms consistent with ARS for HIV screening.
Medical Research: What are the main findings?
Response: We analyzed signs and symptoms in 90 patients diagnosed with acute HIV infection in a community-based program in San Diego that offered universal HIV-1 nucleic acid amplification testing, independent of signs and symptoms. Forty-seven (52%) patients reported ongoing signs or symptoms consistent with ARS on the day of NAT screening. Another 25 (28%) reported signs or symptoms that had occurred during the 14 days before testing, but had resolved by the testing date. Another 12 (13%) reported signs and symptoms that started after the diagnostic test. Only 6/90 (7%) reported no signs and symptoms consistent with ARS. As a secondary finding, viral loads were significantly higher (p=0.001) in the 72 individuals reporting signs and symptoms consistent with ARS before or at the time of NAT screening compared to the 18 participants who did not report signs and symptoms at their diagnostic test. Most frequently reported ARS signs and symptoms included fever, myalgia, fatigue and headache.
Medical Research: What should clinicians and patients take away from your report?
Response: For clinicians and screening programs: Diagnostic strategies that test for acute HIV infection only in those with ongoing signs and symptoms of acute retroviral syndrome may fail to identify about half of persons with AHI. In contrast, HIV-1 NAT provided to persons with signs and symptoms of ARS during the two weeks before HIV screening may identify 80% of AHI cases. Therefore clinicians should assess symptoms that occurred during the previous 14 days and not focus on ongoing symptoms only when deciding whether or not to order a HIV test that detects acute HIV infection .
For individuals at risk for HIV: If you had a recent (i.e. during the last 4 weeks) HIV risk exposure (e.g. unprotected anal intercourse) and experience signs or symptoms of acute retroviral syndrome seek HIV testing with a test that detects AHI.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: Future studies should evaluate specificity of signs and symptoms of ARS, i.e. how frequently these signs and symptoms occur in persons undergoing acute HIV infection testing but test negative.
Medical Research: Is there anything else you would like to add?
Response: Our findings may even have implications for settings that currently use routine the recommended p24 antigen based HIV testing, as these tests are limited by imperfect sensitivities for antibody negative acute HIV infection (sensitivities between 50% and 80%).
Hoenigl M, Green N, Camacho M, Gianella S, Mehta SR, Smith DM, et al. Signs or symptoms of acute HIV infection in a cohort undergoing community-based screening. Emerg Infect Dis. 2016 Mar [date cited]. http://dx.doi.org/10.3201/eid2203.151607
Martin Hoenigl, MD (2016). Signs and Symptoms of Acute Retroviral Infection May Improve Early HIV Detection MedicalResearch.com