Targeted screening of at-risk adults for acute HIV-1 infection in sub-Saharan Africa

作者：Eduard J. Sanders, Elizabeth Wahome, Kimberly A. Powers, Lisa Werner, Greg Fegan, Ludo Lavreys, Clement Mapanje, R. Scott McClelland, Nigel Garrett, William C. Miller, Susan M. Graham · 发表于：AIDS · 年份：2015 · DOI：10.1097/qad.0000000000000924 · 被引用次数：59 · 研究领域：HIV Research and Treatment、HIV-related health complications and treatments、HIV/AIDS Research and Interventions

BACKGROUND: Patients with acute HIV-1 infection (AHI) have elevated infectivity, but cannot be diagnosed using antibody-based testing. Approaches to screen patients for AHI are urgently needed to enable counselling and treatment to reduce onward transmission. METHODS: We pooled data from four African studies of high-risk adults that evaluated symptoms and signs compatible with acute retroviral syndrome and tested for HIV-1 at each visit. AHI was defined as detectable plasma viral load or p24 antigen in an HIV-1-antibody-negative patient who subsequently seroconverted. Using generalized estimating equation, we identified symptoms, signs, and demographic factors predictive of AHI, adjusting for study site. We assigned a predictor score to each statistically significant predictor based on its beta coefficient, summing predictor scores to calculate a risk score for each participant. We evaluated the performance of this algorithm overall and at each site. RESULTS: We compared 122 AHI visits with 45 961 visits by uninfected patients. Younger age (18-29 years), fever, fatigue, body pains, diarrhoea, sore throat, and genital ulcer disease were independent predictors of AHI. The overall area under the receiver operating characteristics curve (AUC) for the algorithm was 0.78, with site-specific AUCs ranging from 0.61 to 0.89. A risk score of at least 2 would indicate AHI testing for 5-50% of participants, substantially decreasing the number needing testing. CONCLUSION: Our targeted ris...