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Risk Factors and Clinical Presentation of Acute Primary HIV Infection in India

Robert C. Bollinger, MD, MPH; Ronald S. Brookmeyer, PhD; Sanjay M. Mehendale, MD, MPH; Ramesh S. Paranjape, PhD; Mary E. Shepherd, MS; Deepak A. Gadkari, PhD; Thomas C. Quinn, MD, MSc
JAMA. 1997;278(23):2085-2089. doi:10.1001/jama.1997.03550230061038.
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Context.  —Most previous studies of clinical presentation and risk factors in early human immunodeficiency virus (HIV) infection have relied on retrospective analyses and referred seroconverters, and thus were subject to possible bias.

Objectives.  —To apply a method based on measurement of prevalent HIV-1 p24 antigenemia for identification of risk factors for newly acquired HIV infection and to describe the signs and symptoms of acute HIV infection.

Design and Setting.  —Nested case-control study in Pune, India. Participants.HIV antibody—negative persons attending 2 sexually transmitted disease (STD) clinics between May 1993 and June 1996.

Outcome Measures.  —Prevalent p24 antigenemia, risk factors for HIV infection, and clinical symptoms of acute primary HIV infection.

Results.  —Of 3874 HIV antibody—negative persons tested, 58 (1.5%) were p24 antigen positive at initial presentation to the clinics. Unprotected sexual contact with a commercial sex worker (CSW) was reported by 39 (77%) of the 51 p24 antigenemic men, compared with 131 (51%) of 255 control men (adjusted odds ratio [AOR], 3.4; 95% confidence interval [CI], 1.2-9.6; P=.02). The presence of an active genital ulcer at the time of screening was found in 46 (79%) of the 58 p24 antigenemic men and women, compared with 137 (47%) of the 290 control subjects (AOR, 4.2; 95% Cl, 2.0-9.0; P<.001). Signs and symptoms independently associated with p24 antigenemia in HIV antibody—seronegative persons included fever, which was reported by 28 (48%) of the 58 p24 antigenemic subjects, but only 52 (18%) of the 290 control subjects (AOR, 4.7; 95% CI, 2.4-9.0; P<.001). Joint pain was reported by 10% of subjects recently HIV infected, compared with 2% of the control subjects (AOR, 6.5; 95% CI, 1.7-24.8; P=.006). Night sweats were reported by 9% of the p24 antigenemic, but only 1% of the control subjects (AOR, 9.1; 95% CI, 1.7-47.6; P=.009). Overall, fever, joint pain, and/or night sweats were reported in 27 (47%) of the 58 subjects with recent HIV infection.

Conclusions.  —This systematic case-control study of p24 antigen screening in HIV-seronegative patients attending STD clinics in India identified unprotected sex with a CSW and a genital ulcer as independent risk factors associated with newly acquired HIV infection. In addition, p24 antigen positivity identified recent fever, night sweats, and arthralgias as symptoms that may be predictive of recent HIV infection. In a study of patients attending STD clinics in India, screening for p24 antigen in HIV antibody—negative persons was found to be a reliable and effective research method for determining recent risk behavior and identifying clinical signs of acute primary HIV infection.


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