Rapid, real-time detection of acute HIV infection in patients in Africa

J Infect Dis. 2007 Feb 1;195(3):416-24. doi: 10.1086/510755. Epub 2006 Dec 22.


Background: We conducted a prospective study to evaluate methods of detecting clients with sexually transmitted diseases (STDs) who were acutely coinfected with human immunodeficiency virus (HIV) in Lilongwe, Malawi.

Methods: After informed consent was obtained, all clients with acute STDs were offered voluntary HIV counseling and testing by 2 rapid antibody tests. Samples from rapid test-negative or -discordant subjects were pooled (50 : 5 : 1) and tested for HIV RNA. Western blots were performed on all rapid test-discordant specimens with detectable HIV RNA. A subset of specimens received p24 antigen testing with standard and/or ultrasensitive methods. Patients with possible acute HIV infection were followed to confirm seroconversion.

Results: A total of 1450 clients (34% female and 66% male) agreed to testing, of whom 588 (40.55%) had established HIV infection and 21 (1.45%) had acute infection. Discordant rapid antibody tests identified 7 of 21 (33.3% sensitivity), standard p24 antigen identified 12 of 16 (75% sensitivity), and ultrasensitive p24 antigen identified 15 of 17 (88% sensitivity) acute cases. By definition, the sensitivity of the RNA assay was 100%.

Conclusions: Real-time pooled RNA testing for the detection of acute HIV infection is feasible in resource-limited settings. However, parallel rapid testing and p24 antigen testing are technologically simpler and together may detect approximately 90% of acute cases.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Disease
  • Adult
  • Blotting, Western
  • Feasibility Studies
  • Female
  • HIV Antibodies / blood
  • HIV Core Protein p24 / blood
  • HIV Infections / blood
  • HIV Infections / diagnosis*
  • HIV Infections / prevention & control
  • HIV* / genetics
  • HIV* / isolation & purification
  • Humans
  • Malawi
  • Male
  • Prospective Studies
  • RNA, Viral / blood
  • Reagent Kits, Diagnostic
  • Sensitivity and Specificity


  • HIV Antibodies
  • HIV Core Protein p24
  • RNA, Viral
  • Reagent Kits, Diagnostic