Challenges of diagnosing acute HIV-1 subtype C infection in African women: performance of a clinical algorithm and the need for point-of-care nucleic-acid based testing

dc.contributor.authorMlisana, Kolekaen_ZA
dc.contributor.authorSobieszczyk, Magdalenaen_ZA
dc.contributor.authorWerner, Liseen_ZA
dc.contributor.authorFeinstein, Addien_ZA
dc.contributor.authorvan Loggerenberg, Francoisen_ZA
dc.contributor.authorNaicker, Nivashneeen_ZA
dc.contributor.authorWilliamson, Carolynen_ZA
dc.contributor.authorGarrett, Nigelen_ZA
dc.date.accessioned2016-01-11T06:53:27Z
dc.date.available2016-01-11T06:53:27Z
dc.date.issued2013en_ZA
dc.description.abstractBACKGROUND: Prompt diagnosis of acute HIV infection (AHI) benefits the individual and provides opportunities for public health intervention. The aim of this study was to describe most common signs and symptoms of AHI, correlate these with early disease progression and develop a clinical algorithm to identify acute HIV cases in resource limited setting. METHODS: 245 South African women at high-risk of HIV-1 were assessed for AHI and received monthly HIV-1 antibody and RNA testing. Signs and symptoms at first HIV-positive visit were compared to HIV-negative visits. Logistic regression identified clinical predictors of AHI. A model-based score was assigned to each predictor to create a risk score for every woman. RESULTS: Twenty-eight women seroconverted after a total of 390 person-years of follow-up with an HIV incidence of 7.2/100 person-years (95%CI 4.5-9.8). Fifty-seven percent reported ≥1 sign or symptom at the AHI visit. Factors predictive of AHI included age <25 years (OR = 3.2; 1.4-7.1), rash (OR = 6.1; 2.4-15.4), sore throat (OR = 2.7; 1.0-7.6), weight loss (OR = 4.4; 1.5-13.4), genital ulcers (OR = 8.0; 1.6-39.5) and vaginal discharge (OR = 5.4; 1.6-18.4). A risk score of 2 correctly predicted AHI in 50.0% of cases. The number of signs and symptoms correlated with higher HIV-1 RNA at diagnosis (r = 0.63; p<0.001). CONCLUSIONS: Accurate recognition of signs and symptoms of AHI is critical for early diagnosis of HIV infection. Our algorithm may assist in risk-stratifying individuals for AHI, especially in resource-limited settings where there is no routine testing for AHI. Independent validation of the algorithm on another cohort is needed to assess its utility further. Point-of-care antigen or viral load technology is required, however, to detect asymptomatic, antibody negative cases enabling early interventions and prevention of transmission.en_ZA
dc.identifier.apacitationMlisana, K., Sobieszczyk, M., Werner, L., Feinstein, A., van Loggerenberg, F., Naicker, N., ... Garrett, N. (2013). Challenges of diagnosing acute HIV-1 subtype C infection in African women: performance of a clinical algorithm and the need for point-of-care nucleic-acid based testing. <i>PLoS One</i>, http://hdl.handle.net/11427/16277en_ZA
dc.identifier.chicagocitationMlisana, Koleka, Magdalena Sobieszczyk, Lise Werner, Addi Feinstein, Francois van Loggerenberg, Nivashnee Naicker, Carolyn Williamson, and Nigel Garrett "Challenges of diagnosing acute HIV-1 subtype C infection in African women: performance of a clinical algorithm and the need for point-of-care nucleic-acid based testing." <i>PLoS One</i> (2013) http://hdl.handle.net/11427/16277en_ZA
dc.identifier.citationMlisana, K., Sobieszczyk, M., Werner, L., Feinstein, A., van Loggerenberg, F., Naicker, N., ... & Garrett, N. (2012). Challenges of diagnosing acute HIV-1 subtype C infection in African women: performance of a clinical algorithm and the need for point-of-care nucleic-acid based testing. PloS one, 8(4), e62928. doi:10.1371/journal.pone.0062928en_ZA
dc.identifier.ris TY - Journal Article AU - Mlisana, Koleka AU - Sobieszczyk, Magdalena AU - Werner, Lise AU - Feinstein, Addi AU - van Loggerenberg, Francois AU - Naicker, Nivashnee AU - Williamson, Carolyn AU - Garrett, Nigel AB - BACKGROUND: Prompt diagnosis of acute HIV infection (AHI) benefits the individual and provides opportunities for public health intervention. The aim of this study was to describe most common signs and symptoms of AHI, correlate these with early disease progression and develop a clinical algorithm to identify acute HIV cases in resource limited setting. METHODS: 245 South African women at high-risk of HIV-1 were assessed for AHI and received monthly HIV-1 antibody and RNA testing. Signs and symptoms at first HIV-positive visit were compared to HIV-negative visits. Logistic regression identified clinical predictors of AHI. A model-based score was assigned to each predictor to create a risk score for every woman. RESULTS: Twenty-eight women seroconverted after a total of 390 person-years of follow-up with an HIV incidence of 7.2/100 person-years (95%CI 4.5-9.8). Fifty-seven percent reported ≥1 sign or symptom at the AHI visit. Factors predictive of AHI included age <25 years (OR = 3.2; 1.4-7.1), rash (OR = 6.1; 2.4-15.4), sore throat (OR = 2.7; 1.0-7.6), weight loss (OR = 4.4; 1.5-13.4), genital ulcers (OR = 8.0; 1.6-39.5) and vaginal discharge (OR = 5.4; 1.6-18.4). A risk score of 2 correctly predicted AHI in 50.0% of cases. The number of signs and symptoms correlated with higher HIV-1 RNA at diagnosis (r = 0.63; p<0.001). CONCLUSIONS: Accurate recognition of signs and symptoms of AHI is critical for early diagnosis of HIV infection. Our algorithm may assist in risk-stratifying individuals for AHI, especially in resource-limited settings where there is no routine testing for AHI. Independent validation of the algorithm on another cohort is needed to assess its utility further. Point-of-care antigen or viral load technology is required, however, to detect asymptomatic, antibody negative cases enabling early interventions and prevention of transmission. DA - 2013 DB - OpenUCT DO - 10.1371/journal.pone.0062928 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Challenges of diagnosing acute HIV-1 subtype C infection in African women: performance of a clinical algorithm and the need for point-of-care nucleic-acid based testing TI - Challenges of diagnosing acute HIV-1 subtype C infection in African women: performance of a clinical algorithm and the need for point-of-care nucleic-acid based testing UR - http://hdl.handle.net/11427/16277 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16277
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0062928
dc.identifier.vancouvercitationMlisana K, Sobieszczyk M, Werner L, Feinstein A, van Loggerenberg F, Naicker N, et al. Challenges of diagnosing acute HIV-1 subtype C infection in African women: performance of a clinical algorithm and the need for point-of-care nucleic-acid based testing. PLoS One. 2013; http://hdl.handle.net/11427/16277.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2013 Mlisana et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherHIV clinical manifestationsen_ZA
dc.subject.otherHIV diagnosis and managementen_ZA
dc.subject.otherHIV infectionsen_ZA
dc.subject.otherSigns and symptomsen_ZA
dc.subject.otherHIV-1en_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherThroaten_ZA
dc.subject.otherUlcersen_ZA
dc.titleChallenges of diagnosing acute HIV-1 subtype C infection in African women: performance of a clinical algorithm and the need for point-of-care nucleic-acid based testingen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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