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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Improved detection of acute HIV-1 infection in sub-Saharan Africa: Development of a risk score algorithm
AIDS, Volume 21, No. 16, Year 2007
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Description
OBJECTIVE: Individuals with acute (preseroconversion) HIV infection (AHI) are important in the spread of HIV. The identification of AHI requires the detection of viral proteins or nucleic acids with techniques that are often unaffordable for routine use. To facilitate the efficient use of these tests, we sought to develop a risk score algorithm for identifying likely AHI cases and targeting the tests towards those individuals. DESIGN: A cross-sectional study of 1448 adults attending a sexually transmitted infections (STI) clinic in Malawi. METHODS: Using logistic regression, we identified risk behaviors, symptoms, HIV rapid test results, and STI syndromes that were predictive of AHI. We assigned a model-based score to each predictor and calculated a risk score for each participant. RESULTS: Twenty-one participants (1.45%) had AHI, 588 had established HIV infection, and 839 were HIV-negative. AHI was strongly associated with discordant rapid HIV tests and genital ulcer disease (GUD). The algorithm also included diarrhea, more than one sexual partner in 2 months, body ache, and fever. Corresponding predictor scores were 1 for fever, body ache, and more than one partner; 2 for diarrhea and GUD; and 4 for discordant rapid tests. A risk score of 2 or greater was 95.2% sensitive and 60.5% specific in detecting AHI. CONCLUSION: Using this algorithm, we could identify 95% of AHI cases by performing nucleic acid or protein tests in only 40% of patients. Risk score algorithms could enable rapid, reliable AHI detection in resource-limited settings. © 2007 Lippincott Williams & Wilkins, Inc.
Authors & Co-Authors
Powers, Kimberly A.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Miller, William C.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Pilcher, Christopher D.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
United States, San Francisco
University of California, San Francisco
Mapanje, Clement
Malawi, Lilongwe
Kamuzu Central Hospital
Martinson, Francis E.A.
Malawi, Lilongwe
Kamuzu Central Hospital
Fiscus, Susan A.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Chilongozi, David A.T.
Malawi, Lilongwe
Kamuzu Central Hospital
Namakhwa, David
Malawi, Lilongwe
Kamuzu Central Hospital
Price, Matt A.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
United States, New York
International Aids Vaccine Initiative
Galvin, Shannon R.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Hoffman, Irving F.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Cohen, Myron S.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Statistics
Citations: 100
Authors: 12
Affiliations: 4
Identifiers
Doi:
10.1097/QAD.0b013e3282f08b4d
Research Areas
Health System And Policy
Infectious Diseases
Sexual And Reproductive Health
Study Design
Cross Sectional Study
Study Approach
Quantitative
Study Locations
Malawi