Frequent detection of acute primary HIV infection in men in Malawi

AIDS. 2004 Feb 20;18(3):517-24. doi: 10.1097/00002030-200402200-00019.

Abstract

Background: Acute (antibody-negative) HIV infection is associated with high transmission potential but is rarely recognized.

Design: Cross-sectional study.

Methods: We examined the prevalence and predictors of acute HIV infection among 1361 consecutive male outpatients attending sexually transmitted disease (STD; n = 929) and dermatology (n = 432) clinics in Lilongwe, Malawi. Serum specimens negative for HIV antibodies were screened by HIV RNA PCR using a highly specific pooling/resolution testing algorithm.

Results: Five-hundred and fifty-three men (40.6%) were HIV antibody positive and 24 (1.8%) had acute HIV infection; 23 of 24 acutely infected men were from the STD clinic, where they represented 4.5% of all HIV antibody-negative men and 5.0% of all HIV infections. HIV RNA levels for acutely infected men were significantly higher [median (interquartile range), 6.10 (5.19-6.54) log10 HIV RNA copies/ml] than for 58 HIV antibody-positive men [4.42 (3.91-4.95) log10 copies/ml; P < 0.0001]. The factor most strongly associated with acute HIV infection was STD clinic attendance: (odds ratio, 15.2; 95% confidence interval, 2.04-113.0). In multivariate analysis considering only STD patients, factors associated with acute HIV infection included inguinal adenopathy, genital ulceration and age 24-26 years, the age stratum associated with peak incidence of HIV infection among Malawian men.

Conclusions: Traditional HIV antibody tests alone are not sufficient to exclude HIV infection among men with acute STD in Malawi due to a surprising proportion of acute HIV infections in this population. Alternative screening methods are required for diagnosis of acute HIV infection; such screening could be important for research and for prevention of the sexual transmission of HIV in select populations.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Adult
  • Ambulatory Care Facilities
  • Epidemiologic Methods
  • HIV Infections / diagnosis
  • HIV Infections / epidemiology*
  • HIV Infections / virology
  • HIV-1*
  • Humans
  • Malawi / epidemiology
  • Male
  • Mass Screening
  • Patient Acceptance of Health Care / statistics & numerical data
  • Prevalence
  • Viral Load