aCentre for Geographic Medicine Research - Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya bNuffield Department of Clinical Medicine, University of Oxford, Headington, UK cCounty Health Office, Kilifi, Kenya dNuffield Department of Population Health, University of Oxford, Headington, UK eUniversity of Nairobi, Nairobi, Kenya fUniversity of Washington, Seattle, Washington, USA. *Peter Mugo and Henrieke A.B. Prins contributed equally to the writing of this article.
AIDS. 2014 Jun 1;28(9):1357-63. doi: 10.1097/QAD.0000000000000245.
Febrile adults are usually not tested for acute HIV-1 infection (AHI) in Africa. We assessed a strategy to diagnose AHI among young adult patients seeking care.
Young adults (<30 years) who met predefined AHI criteria at care seeking, including fever, sexually transmitted disease symptoms, diarrhoea, body pains or multiple partners were referred from five pharmacies and screened at five health facilities. Prevalent HIV-1 was diagnosed by nationally recommended serial rapid HIV-1 testing. Willing HIV-1-negative patients were evaluated for AHI, defined as a positive p24 antigen test, and subsequent seroconversion or RNA detection. Febrile patients evaluated for AHI were also screened for malaria using a rapid test, with PCR confirmation of positives.
In 3602 adults seeking care, overall HIV-1 prevalence was 3.9%: 7.6% (68/897) among patients meeting AHI criteria vs. 2.6% (71/2705) among those who did not (P < 0.001). AHI was diagnosed in five of 506 HIV-1-negative or discordant patients who met AHI risk criteria and were completely evaluated [prevalence 1.0%, 95% confidence interval (CI) 0.3-2.3%]. Of these five AHI cases, four were diagnosed among the 241 patients with fever (prevalence 1.7%, 95% CI 0.5-4.2%), vs. one among 265 non-febrile patients (prevalence 0.4%, 95% CI 0.0-2.0%, P = 0.1). Malaria was confirmed by PCR in four (1.7%) of the 241 febrile patients.
AHI was as common as confirmed malaria in young febrile adults seeking care. An AHI detection strategy targeting young febrile adults seeking care at pharmacies and health facilities is feasible and should be considered as an HIV-prevention strategy in high-transmission settings.
在非洲，发热的成年人通常不会接受急性 HIV-1 感染（AHI）的检测。我们评估了一种在寻求医疗的年轻成年患者中诊断 AHI 的策略。
在五个药房就诊时，符合预先设定的 AHI 标准（包括发热、性传播疾病症状、腹泻、身体疼痛或多个性伴侣）的年轻成年人（<30 岁）被转诊至五个卫生设施进行筛查。通过国家推荐的连续快速 HIV-1 检测诊断现患 HIV-1。愿意接受 HIV-1 阴性的患者接受 AHI 评估，定义为 p24 抗原检测阳性，随后发生血清转换或 RNA 检测。评估 AHI 的发热患者也使用快速检测筛查疟疾，阳性者用 PCR 确认。
在 3602 名就诊的成年人中，总体 HIV-1 流行率为 3.9%：符合 AHI 标准的患者中为 7.6%（68/897），不符合的患者中为 2.6%（71/2705）（P<0.001）。在符合 AHI 风险标准且接受全面评估的 506 名 HIV-1 阴性或不一致的患者中，有五名诊断为 AHI [流行率为 1.0%，95%置信区间（CI）为 0.3-2.3%]。这五例 AHI 中有四例发生在 241 例发热患者中（流行率为 1.7%，95%CI 为 0.5-4.2%），而在 265 例非发热患者中仅一例（流行率为 0.4%，95%CI 为 0.0-2.0%，P=0.1）。PCR 确认在 241 例发热患者中，有 4 例（1.7%）确诊疟疾。
在寻求医疗的年轻发热成年人中，AHI 与确诊疟疾一样常见。在药房和卫生设施针对寻求医疗的年轻发热成年人的 AHI 检测策略是可行的，应在高传播环境中考虑作为 HIV 预防策略。
