FR AX 0102

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Inhaltsübersicht: Kongressbericht Wien 2010

High prevalence of symptomatic acute HIV infection in an outpatient ward in Southern Mozambique: identification and follow up

Presented by Celia Serna-Bolea (Spain).

C. Serna-Bolea1, J. Muñoz1,2, J.M. Almeida2, A. Nhacolo2, E. Letang1, T. Nhampossa2,3, E. Ferreira3,4, P. Alonso1,2, D. Naniche1,2

1Barcelona Centre for International Health Research (CRESIB), Hospital Clinic, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universtitat de Barcelona, Barcelona, Spain, 2Manhiça Health Research Centre (CISM), Manhiça, Mozambique, 3Instituto Nacional de Saúde, Ministerio de Saúde, Maputo, Mozambique, 4Centro de Saúde de Manhiça, Manhiça, Mozambique

Background: HIV-infected individuals are considered hyperinfectious from the onset of acute HIV infection (AHI) up to 6 weeks thereafter. It has been suggested that this phase may be crucial in fuelling the HIV pandemic. Approximately half of patients with AHI develop non-specific fever and flu symptoms. In Southern Mozambique, although approximately 30% of fevers are due to malaria, most of the remaining fevers have unknown aetiology. The objective of the study was to determine the prevalence of AHI within the HIV-seronegative adult population presenting with reported fever in a district hospital in southern Mozambique and evaluate clinical, immunological and virological parameters of AHI.
Methods: Three hundred and forty-six adults presenting with reported fever at an outpatient ward at the Manhiça District Hospital (Mozambique) were screened for AHI by HIV serology testing, followed by HIV-RNA testing in HIV-seronegative individuals. Plasma from HIV-seronegative patients was pooled 1 : 5 for HIV-RNA testing. Whole blood was used for Plasmodium falciparum rapid-test determination at screening visit. Follow-up visits at day 7, 4 and 10 months included clinical examination, HIV serotesting, assessment of HIV-RNA, CD4 cell counts and percentage of activated CD8 T cells.
Results: HIV serotesting revealed that 37.8% (95% CI 32.7-43.2) of the adults had previously undiagnosed established HIV infection. Among the HIV-seronegative patients, 3.3% (95% CI 1.3-6.7) had AHI by positive HIV-1 RNA testing. Median HIV-1 RNA levels at diagnosis of AHI were 6.21 log10 copies/ml (IQR 5.92-6.41) and significantly higher than at 4 months. At day 7 after screening, patients showed a median CD4 cell count of 384 cells/ml (IQR 239-441) and a median percentage of activated CD8 T cells of 68.4% (IQR 59.6-87.8).
Conclusions: High prevalence of AHI in southern African populations may warrant investigation of tools and target populations for AHI screening as a novel way to address HIV prevention.


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