Diagnosis Of Primary HIV Infection Research Articles

Does testosterone intake affect diagnosing primary HIV infection?

Diagnosis of primary HIV infection may be disrupted by many factors, one of which are drugs such as exogenous steroids. We report a rare case of a 37-year-old male patient, undergoing testosterone treatment in the course of Klinefelter syndrome. He presented with the general symptoms of fever, weakness and diarrhea lasting for 2 weeks. He also had incorrect results of laboratory studies. The fourth generation ELISA HIV test indicated negative outcomes. The HIV real time polymerase chain reaction test was performed and showed very high plasma viral load, over 107 copies/ml. We discuss the connection between androgen replacement therapy used in Klinefelter syndrome and the diagnosis of PHI. This case report illustrates the importance of obtaining a detailed medical history, especially of chronic diseases and medications, and applying appropriate diagnostic tests.

Immunoblots may not be effective in confirming the recency of HIV-1 infection

Recently, immunoblots (IBs) have tended to substitute Western blots (WBs) for HIV infection diagnosis. Several studies have confirmed IBs’ high sensitivity to confirm HIV infection for every stage. Since the nature and pattern of the antigens of IBs are different from those of WB, the abilities of IBs and WBs to distinguish the stages of recent seroconversion and open-ended chronic infection might differ. We aimed to evaluate the performance of two IBs (INNO-LIA™ HIVI/II, Fujirebio, and Geenius™ HIV1/2 Confirmatory assay, Bio-Rad) to define the stage of infection. We studied 53 patients from the French ANRS CO6 PRIMO cohort. IBs have higher positive rates than WB. However, Geenius was less sensitive than WB and INNO-LIA to detect antibodies to p31 (0% vs 22.6 % and 15.1 %, respectively), so it could wrongly label late Fiebig stage and open-ended chronic infections as recent infections (n = 5/53). For the first time, we provide evidence that centralized WBs associated with an enzyme immunoassay for the identification of recent HIV-1 infection support the establishment of a more accurate diagnosis of primary HIV infection to improve the accuracy of enrollments in cohorts of recent HIV infections useful for epidemiological studies, pathogenesis studies or therapeutic trials.

The Early Bird Gets the Worm: Benefits and Future Directions With Early Antiretroviral Therapy Initiation in Primary Hiv Infection

Primary HIV infection is defined as the first few weeks after infection where plasma viremia is rapidly increasing. Early diagnosis of primary HIV infection enhances the tendency of behavioral changes in newly infected individuals to prevent secondary HIV transmission. Early antiretroviral therapy (ART) benefits individuals by reducing plasma viral load, gut damage, microbial translocation and subsequent systemic immune activation. Early ART leads to the establishment of low HIV reservoir size that may contribute to HIV eradication research. However, substantial diagnostic and logistical barriers remain as a burden to rapid diagnosis and early treatment initiation. In this review, we critically evaluate the effects of early ART and summarize hurdles that must be addressed to implement rapid treatment initiation for newly infected individuals.

Acute Appendicitis as the Initial Clinical Presentation of Primary HIV-1 Infection.

We report a case of an adolescent who presented at our emergency department with acute abdominal pain. While the initial diagnosis was acute appendicitis, a secondary and coincidental diagnosis of primary HIV-1 infection was made. Concurrent and subsequent clinical and molecular biology findings form the basis of our argument that primary HIV-1 infection was the cause of acute appendicitis in this individual.

Rapidly declining HIV infection in MSM in central London

Rapidly declining HIV infection in MSM in central London

HIV-Test und Prävention

Successful prevention of an HIV epidemic is still a desirable goal. As young people are mainly affected by new infections and AIDS mortality has fallen virtually to zero, the long-term total costs of HIV management are increasing. This report describes how the targeted application of HIV testing can influence the HIV epidemic. The crucial point is the early diagnosis of primary HIV infection in standard situations whereby early diagnosis and counselling result in behavioral modifications preventing new transmission.

Early Diagnosis of Primary HIV Infection by Fourth Generation ELISA in Spouses of HIV-Positive Patients and STD Clinic Attendees

Early Diagnosis of Primary HIV Infection by Fourth Generation ELISA in Spouses of HIV-Positive Patients and STD Clinic Attendees

Acute retroviral syndrome and high baseline viral load are predictors of rapid HIV progression among untreated Argentinean seroconverters

BackgroundDiagnosis of primary HIV infection (PHI) has important clinical and public health implications. HAART initiation at this stage remains controversial.MethodsOur objective was to identify predictors of disease progression among Argentinean seroconverters during the first year of infection, within a multicentre registry of PHI-patients diagnosed between 1997 and 2008. Cox regression was used to analyze predictors of progression (LT-CD4 < 350 cells/mm3, B, C events or death) at 12 months among untreated patients.ResultsAmong 134 subjects, 74% presented with acute retroviral syndrome (ARS). Seven opportunistic infections (one death), nine B events, and 10 non-AIDS defining serious events were observed. Among the 92 untreated patients, 24 (26%) progressed at 12 months versus three (7%) in the treated group (p = 0.01). The 12-month progression rate among untreated patients with ARS was 34% (95% CI 22.5-46.3) versus 13% (95% CI 1.1-24.7) in asymptomatic patients (p = 0.04). In univariate analysis, ARS, baseline LT-CD4 < 350 cells/mm3, and baseline and six-month viral load (VL) > 100,000 copies/mL were associated with progression. In multivariate analysis, only ARS and baseline VL > 100,000 copies/mL remained independently associated; HR: 8.44 (95% CI 0.97-73.42) and 9.44 (95% CI 1.38-64.68), respectively.ConclusionsIn Argentina, PHI is associated with significant morbidity. HAART should be considered in PHI patients with ARS and high baseline VL to prevent disease progression.

Undetectable HIV‐1 RNA load with the Cobas TaqMan v1.0 in a patient diagnosed at the time of primary HIV‐1 infection

Diagnosis of primary HIV-1 infection is challenging due to the presence of a serological window; thus, HIV-1-RNA quantitation and/or measurement of p24 antigenemia are recommended in such cases. A patient was diagnosed at the time of primary HIV-1 infection, he harbored a CFR02_AG subtype virus; quantitation of plasma HIV-1-RNA yielded an undetectable result according to one commercial assay, while HIV-1-RNA was detectable when measured with three other assays.

Unusual primary HIV infection with colonic ulcer complicated by hemorrhagic shock: a case report

IntroductionTimely diagnosis of primary HIV infection is important to prevent further transmission of HIV. Primary HIV infection may take place without symptoms or may be associated with fever, pharyngitis or headache. Sometimes, the clinical presentation includes aseptic meningitis or cutaneous lesions. Intestinal ulceration due to opportunistic pathogens (cytomegalovirus, Epstein-Barr virus, Toxoplasma gondii) has been described in patients with AIDS. However, although invasion of intestinal lymphoid tissue is a prominent feature of human and simian lentivirus infections, colonic ulceration has not been reported in acute HIV infection.Case descriptionA 42-year-old Caucasian man was treated with amoxicillin-clavulanate for pharyngitis. He did not improve, and a rash developed. History taking revealed a negative HIV antibody test five months previously and unprotected sex with a male partner the month before admission. Repeated tests revealed primary HIV infection with an exceptionally high HIV-1 RNA plasma concentration (3.6 × 107 copies/mL) and a low CD4 count (101 cells/mm3, seven percent of total lymphocytes). While being investigated, the patient had a life-threatening hematochezia. After angiographic occlusion of a branch of the ileocaecal artery and initiation of antiretroviral therapy, the patient became rapidly asymptomatic and could be discharged. Colonoscopy revealed a bleeding colonic ulcer. We were unable to identify an etiology other than HIV for this ulcer.ConclusionThis case adds to the known protean manifestation of primary HIV infection. The lack of an alternative etiology, despite extensive investigations, suggests that this ulcer was directly caused by primary HIV infection. This conclusion is supported by the well-described extensive loss of intestinal mucosal CD4+ T cells associated with primary HIV infection, the extremely high HIV viral load observed in our patient, and the rapid improvement of the ulcer after initiation of highly active antiretroviral therapy. This case also adds to the debate on treatment for primary HIV infection, especially in the context of severe symptoms and an extremely high viral load.

It's not all swine flu…are we missing opportunities to diagnose primary HIV infection in patients with flu symptoms?

The advantages of diagnosis of primary HIV infection (PHI) for the individual and public health are well documented. However, symptoms of HIV seroconversion are often not recognized by health-care professionals. Also, symptomatic patients themselves often do not present to health-care services. With the emergence of H1N1 infection, many patients with flu-like symptoms are seeking medical advice. Currently in the UK, the management of H1N1 is in the treatment phase, that is, patients are diagnosed and treated for H1N1 influenza based on clinical observation rather than laboratory testing. Symptoms of H1N1 infection are often similar to those of PHI. We present two cases of men who have sex with men from Brighton, UK presenting to general practice and accident and emergency with flu-like symptoms. Both were initially diagnosed on clinical grounds with H1N1 infection and treated empirically with antivirals but were later confirmed to, in fact, have symptomatic PHI. It is important in high-risk patients with flu symptoms attributed to swine flu infection, that PHI is also considered and excluded.

Reductions in HIV transmission risk behaviour following diagnosis of primary HIV infection: a cohort of high‐risk men who have sex with men

Risk-reduction counselling is a standard preventive intervention, but behaviour change is difficult to sustain over the duration of HIV infection. However, primary HIV infection (PHI) is highly infectious and plays a key role in transmission - especially through dense sexual networks - but is short term, so even transient risk reduction can mitigate its high infectivity. Targeting behaviour-change interventions at recently infected individuals may be highly effective, particularly in higher risk groups. We explored the potential impact on HIV transmission-risk behaviour of PHI diagnosis in men who have sex with men (MSM). MSM with PHI were interviewed at diagnosis and after 3 months of follow-up about their sexual behaviour in the 12-week periods before and after diagnosis and standard counselling. A total of 98 of 104 eligible MSM (94%) participated in the study, with 100% follow-up. PHI was associated with high levels of recreational drug use, low levels of condom use, high numbers of sexual partners and a history of sex work. In the 12 weeks post-diagnosis, 76% of participants eliminated risk of onward transmission entirely and, overall, there was a significant reduction in transmission-risk behaviour, with patients reporting greater condom use and fewer sexual partners. Those with continued transmission-risk behaviour were more likely to have another sexually transmitted infection (STI), use ketamine and have more sexual partners at baseline. Most MSM recently diagnosed with PHI changed their behaviour to substantially reduce the risk of onward HIV transmission. Strategies are needed to (a) increase diagnoses of PHI to target prevention efforts effectively and (b) further reduce risk behaviours by targeting enhanced counselling to those most likely to continue with risk behaviours.

Primary HIV-1 Infection Among Infants in Sub-Saharan Africa: HPTN 024

Our objectives were to assess clinical signs and diagnoses associated with primary HIV-1 infection among infants. We analyzed data from a clinical trial (HIV Prevention Trials Network Protocol 024) in sub-Saharan Africa. Study visits were conducted at birth, at 4-6 weeks, and at 3, 6, 9, and 12 months. The study population comprised live born, singleton, first-born infants of HIV-1-infected women with negative HIV-1 RNA assays who were still breastfeeding at 4-6 weeks. Of 1317 HIV-1-exposed infants, 84 became HIV-1 infected after 4-6 weeks and 1233 remained uninfected. There were 102 primary and 5650 nonprimary infection visits. The most common signs were cough and diarrhea, and the most common diagnoses were malaria and pneumonia. Primary infection was associated with significantly increased odds of diarrhea [odds ratio (OR) = 2.4], pneumonia (OR = 3.5), otitis media (OR = 3.1), and oral thrush (OR = 2.9). For the clinical signs and diagnoses evaluated, sensitivity was low (1%-16.7%) and specificity was high (88.2%-99%). Positive predictive values ranged from 0.1%-1.4%. Negative predictive values ranged from 28.0%-51.1%. Certain clinical signs and diagnoses, although more common during primary HIV-1 infection, had low sensitivity and high specificity. Efforts to expand access to laboratory assays for the diagnosis of primary HIV-1 infection among infants of HIV-1-infected women should be emphasized.

Primary HIV infection with multisystemic presentation

Establishing a diagnosis of primary HIV infection (PHI) is important for both the affected individual and public health, because the newly infected individual might readily transmit HIV to others. Unfortunately, diagnosing PHI is hindered by its non-specific presentation, among other factors. We report the case of a patient with extensive multiple organ involvement (fever, rhabdomyolysis, myocarditis, pancreatitis, bilateral renal infarcts, acute renal failure and anemia) in the setting of documented HIV seroconversion as an unusual form of PHI.

Primary HIV infection presenting as haemolytic crisis in a patient with previously undiagnosed glucose 6-phosphate dehydrogenase deficiency

Primary HIV infection presenting as haemolytic crisis in a patient with previously undiagnosed glucose 6-phosphate dehydrogenase deficiency

Clinical presentation and diagnosis of primary HIV-1 infection

To describe current findings concerning the clinical manifestations and diagnosis of primary HIV-1 infection. HIV-1 seroconversion can occur with a variety of clinical manifestations or without symptoms. More severe and numerous symptoms during primary HIV-1 infection predict a higher plasma HIV-1 RNA set-point and faster disease progression. While detection of primary HIV-1 infection is potentially very important for HIV-1 prevention and may offer clinical benefits, the diagnosis is often missed. Diagnosis of symptomatic individuals with antibody-negative HIV-1 infection requires recognition of the diverse signs and symptoms of this syndrome. Diagnostic tests for primary HIV-1 infection include assays for HIV-1 RNA, p24 antigen, and third generation enzyme immunoassay antibody tests capable of detecting IgM antibodies. Targeting these tests using clinical presentation alone will probably miss the diagnosis in many individuals. Consequently, increasing effort has gone into developing strategies to incorporate the use of these assays into routine HIV-1 testing algorithms. More numerous and severe primary HIV-1 infection symptoms predict more rapid disease progression. Pooled HIV-1 RNA screening and fourth generation HIV-1 enzyme immunoassay antibody tests with sensitive p24 antigen detection are beginning to be implemented in routine HIV-1 testing algorithms, but further research is needed to define optimal strategies for increasing detection of primary HIV-1 infection.

Epidemiology of primary HIV-1 infection

To review recent studies reporting epidemiological and public health aspects of primary and recently acquired HIV infection, with a particular emphasis on patterns of occurrence, relationship to onward transmission, diagnostic strategies and risk factors. Diagnosis of primary HIV infection remains a relatively infrequent occurrence. Clinical and demographic characteristics may be helpful indicators to guide the decision to offer testing. The high levels of viraemia associated with primary HIV infection represent a particular risk of onward transmission, as recently demonstrated through studies using genotyping methods to link newly acquired cases. Diagnostic strategies involving nucleic acid detection have been increasingly used to identify cases prior to the development of antibodies. Serological tests for early infection are valid for epidemiological purposes but are not generally viewed reliable enough for individual diagnosis. Prospective studies continue to be a useful means of identifying factors associated with the risk of newly acquired HIV infection, and can guide the implementation and evaluation of prevention strategies. The occurrence of primary HIV infection is an event of public health importance. Understanding of the extent of primary HIV infection and its risk factors in populations can guide the development and evaluation of preventive interventions.

Rhabdomyolyse aiguë associée à une primo-infection à VIH-1 : une nouvelle observation

Introduction Acute human immunodeficiency virus type 1 infection is a clinical and biological misleading and often undiagnosed illness. Laboratory studies frequently demonstrate abnormalities. Acute rhabdomyolysis is rarely reported. Exegesis Authors report the case of an African man who presented with acute fever, cough, diarrhea, conjunctivitis, thrombocytopenia, lymphopenia, and rhabdomyolysis without other possible cause. HIV test and detection of plasma p24 antigen were initially negative but were controlled positive and associated with high level of viral RNA. Conclusion Symptomatic primary human immunodeficiency virus infection presenting with acute rhabdomyolysis was diagnosed. Diagnosis of primary HIV-1 infection must be considered in young people and patients at risk who present with acute rhabdomyolysis and fever.

Drug-resistance mutations can be archived very early in HIV primary infection

Recent guidelines include clear recommendations for resistance testing in individuals infected by HIV for less than 2 years with the assumption that within 1--2 years most drug-resistance mutations (DRM) would be overgrown by wild-type virus. Recent studies addressed at monitoring the persistence of resistance-associated mutations after HIV transmission to untreated patients indicate that certain DRM are highly stable and may persist at detectable levels for many years. The usefulness of genotypic testing in all drug-naive patients in most settings is under debate. The picture of the events that occur in naive patients is probably complex and a different and more frequent analysis probably needs to be performed. (excerpt)

Treatment for primary HIV infection: projecting outcomes of immediate, interrupted, or delayed therapy.

With limited data available on the optimal treatment of primary HIV infection, disease modeling can be used to project clinical outcomes and inform decision makers. The authors developed a simulation model to evaluate the clinical outcomes and life expectancy projections for three primary HIV infection treatment strategies: 1) continuous antiretroviral therapy (ART) initiated at CD4 count <350 cells/mm(3); 2) continuous ART initiated immediately on diagnosis of primary HIV infection; and 3) ART initiated on diagnosis followed by structured treatment interruption. Projected life expectancies for the three strategies were 23.92, 24.46, and 26.07 years, respectively. The impact of key variables was assessed in sensitivity analysis, with the structured treatment interruption strategy remaining the most effective over a broad range of inputs. The immunologic benefit associated with immediate therapy and the potential for antiretroviral resistance due to structured treatment interruption have the most important impact on the optimal strategy. Based on current data, immediate treatment on diagnosis of primary HIV infection followed by structured treatment interruption will likely yield the best outcome. These results can assist decision makers and those planning clinical trials in defining evidence-based performance measures for primary HIV infection treatment and future trials.