FR AX 0102

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. Muñoz^1,2, J.M. Almeida², A. Nhacolo², E. Letang¹, T. Nhampossa^2,3, E. Ferreira^3,4, P. Alonso^1,2, D. Naniche^1,2

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.

Links:

• Serna-Bolea, et.al.-FRAX0102
• Slides mit Audio
• Präsentation (.ppt)