在圣地亚哥社区为基础的筛查计划中，一种用于急性人类免疫缺陷病毒感染的简单症状评分。
A Simple Symptom Score for Acute Human Immunodeficiency Virus Infection in a San Diego Community-Based Screening Program.
机构信息
University of California, San Diego School of Medicine, La Jolla.
Division of Infectious Diseases, Department of Medicine, University of California, San Diego.
出版信息
Clin Infect Dis. 2018 Jun 18;67(1):105-111. doi: 10.1093/cid/cix1130.
BACKGROUND
Treatment of acute human immunodeficiency virus (HIV) infection (AHI) decreases transmission and preserves immune function, but AHI diagnosis remains resource intensive. Risk-based scores predictive for AHI have been described for high-risk groups; however, symptom-based scores could be more generalizable across populations.
METHODS
Adults who tested either positive for AHI (antibody-negative, HIV nucleic acid test [NAT] positive) or HIV NAT negative with the community-based San Diego Early Test HIV screening program were retrospectively randomized 2:1 into a derivation and validation set. In the former, symptoms significant for AHI in a multivariate logistic regression model were assigned a score value (the odds ratio [OR] rounded to the nearest integer). The score was assessed in the validation set using receiver operating characteristics and areas under the curve (AUC). An optimal cutoff score was found using the Youden index.
RESULTS
Of 998 participants (including 261 non-men who have sex with men [MSM]), 113 had AHI (including 4 non-MSM). Compared to HIV-negative cases, AHI cases reported more symptoms (median, 4 vs 0; P < .01). Fever, myalgia, and weight loss were significantly associated with AHI in the multivariate model and corresponded to 11, 8, and 4 score points, respectively. The summed score yielded an AUC of 0.85 (95% confidence interval [CI], .77-.93). A score of ≥11 was 72% sensitive and 96% specific (diagnostic OR, 70.27).
CONCLUSIONS
A 3-symptom score accurately predicted AHI in a community-based screening program and may inform allocation of resources in settings that do not routinely screen for AHI.
背景
治疗急性人类免疫缺陷病毒（HIV）感染（AHI）可降低传播率并维持免疫功能，但 AHI 的诊断仍然需要大量资源。已经为高风险人群描述了基于风险的预测 AHI 的评分，但基于症状的评分可能更具普遍性。
方法
通过基于社区的圣地亚哥早期检测 HIV 筛查计划，检测到 AHI（抗体阴性，HIV 核酸检测[NAT]阳性）或 HIV NAT 阴性的成年人，回顾性地以 2:1 的比例随机分配到推导和验证组。在前一组中，多变量逻辑回归模型中与 AHI 相关的症状被赋予评分值（最接近整数的比值比[OR]）。使用接收者操作特征和曲线下面积（AUC）在验证组中评估该评分。使用约登指数找到最佳截断评分。
结果
在 998 名参与者（包括 261 名非男男性行为者[MSM]）中，有 113 名患有 AHI（包括 4 名非 MSM）。与 HIV 阴性病例相比，AHI 病例报告的症状更多（中位数为 4 与 0；P <.01）。发热、肌痛和体重减轻在多变量模型中与 AHI 显著相关，分别对应 11、8 和 4 个评分点。总评分的 AUC 为 0.85（95%置信区间[CI]，0.77-0.93）。得分≥11 的灵敏度为 72%，特异性为 96%（诊断 OR，70.27）。
结论
在社区筛查计划中，3 症状评分准确预测 AHI，这可能为不常规筛查 AHI 的环境分配资源提供信息。
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