ArticlePloS one2013
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.
Article in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 24 citations in OpenAlex.
- High Burden of Symptomatic and Asymptomatic Sexually Transmitted Infections in a Routine Decentralised HIV Care Setting in Eswatini: A Cross-Sectional Study.Tropical medicine & international health : TM & IH · 2025Article
- Predicting, Diagnosing, and Treating Acute and Early HIV Infection in a Public Sector Facility in Eswatini.Journal of acquired immune deficiency syndromes (1999) · 2021Article
- Clinical and public health implications of acute and early HIV detection and treatment: a scoping review.Journal of the International AIDS Society · 2017Article
- Development and validation of a risk score to assist screening for acute HIV-1 infection among men who have sex with men.BMC infectious diseases · 2017Article
- Detection of Acute and Early HIV-1 Infections in an HIV Hyper-Endemic Area with Limited Resources.PloS one · 2016Article
- Targeted screening of at-risk adults for acute HIV-1 infection in sub-Saharan Africa.AIDS (London, England) · 2015Article
- The HIV treatment cascade in acutely infected people: informing global guidelines.Current opinion in HIV and AIDS · 2015Review
- Brief Report: Health-Seeking Behavior and Symptoms Associated With Early HIV Infection: Results From a Population-Based Cohort in Southern Malawi.Journal of acquired immune deficiency syndromes (1999) · 2015Article
- How can we better identify early HIV infections?Current opinion in HIV and AIDS · 2015Review
- Impact of antiretroviral therapy on health-related quality of life among South African women in the CAPRISA 002 acute infection study.AIDS and behavior · 2014Article
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundPrompt 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.
methods245 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.
resultsTwenty-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).
conclusionsAccurate 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.
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