Risk factors and clinical presentation of acute primary HIV infection in India
R. C. Bollinger, R. S. Brookmeyer, S. M. Mehendale, R. S. Paranjape, M. E. Shepherd, D. A. Gadkari and T. C. Quinn
Division of Infectious Diseases, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md 21205, USA.
CONTEXT: Most previous studies of clinical presentation and risk factors in
early human immunodeficiency virus (HIV) infection have relied on
retrospective analyses and referred seroconverters, and thus were subject
to possible bias. OBJECTIVES: To apply a method based on measurement of
prevalent HIV-1 p24 antigenemia for identification of risk factors for
newly acquired HIV infection and to describe the signs and symptoms of
acute HIV infection. DESIGN AND SETTING: Nested case-control study in Pune,
India. PARTICIPANTS: HIV antibody-negative persons attending 2 sexually
transmitted disease (STD) clinics between May 1993 and June 1996. OUTCOME
MEASURES: Prevalent p24 antigenemia, risk factors for HIV infection, and
clinical symptoms of acute primary HIV infection. RESULTS: Of 3874 HIV
antibody-negative persons tested, 58 (1.5%) were p24 antigen positive at
initial presentation to the clinics. Unprotected sexual contact with a
commercial sex worker (CSW) was reported by 39 (77%) of the 51 p24
antigenemic men, compared with 131 (51 %) of 255 control men (adjusted odds
ratio [AOR], 3.4; 95% confidence interval [CI], 1.2-9.6; P=.02). The
presence of an active genital ulcer at the time of screening was found in
46 (79%) of the 58 p24 antigenemic men and women, compared with 137 (47%)
of the 290 control subjects (AOR, 4.2; 95% CI, 2.0-9.0; P<.001). Signs
and symptoms independently associated with p24 antigenemia in HIV
antibody-seronegative persons included fever, which was reported by 28
(48%) of the 58 p24 antigenemic subjects, but only 52 (18%) of the 290
control subjects (AOR, 4.7; 95% CI, 2.4-9.0; P<.001). Joint pain was
reported by 10% of subjects recently HIV infected, compared with 2% of the
control subjects (AOR, 6.5; 95% CI, 1.7-24.8; P=.006). Night sweats were
reported by 9% of the p24 antigenemic, but only 1% of the control subjects
(AOR, 9.1; 95% CI, 1.7-47.6; P=.009). Overall, fever, joint pain, and/or
night sweats were reported in 27 (47%) of the 58 subjects with recent HIV
infection. CONCLUSIONS: This systematic case-control study of p24 antigen
screening in HIV-seronegative patients attending STD clinics in India
identified unprotected sex with a CSW and a genital ulcer as independent
risk factors associated with newly acquired HIV infection. In addition, p24
antigen positivity identified recent fever, night sweats, and arthralgias
as symptoms that may be predictive of recent HIV infection. In a study of
patients attending STD clinics in India, screening for p24 antigen in HIV
antibody-negative persons was found to be a reliable and effective research
method for determining recent risk behavior and identifying clinical signs
of acute primary HIV infection.
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