Diagnosis of primary HIV-1 infection. Los Angeles County Primary HIV Infection Recruitment Network.
BACKGROUND
The optimal approach for diagnosing primary HIV-1 infection has not been defined.


OBJECTIVE
To determine the usefulness of symptoms and virologic tests for diagnosing primary HIV-1 infection.


METHODS
Prospective cohort study.


METHODS
A teaching hospital in Los Angeles and a university research center in San Diego, California.


METHODS
436 patients who had symptoms consistent with primary HIV infection.


METHODS
Clinical information and levels of HIV antibody, HIV RNA, and p24 antigen.


RESULTS
Primary infection was diagnosed in 54 patients (12.4%). The sensitivity and specificity of the p24 antigen assay were 88.7% (95% CI, 77.0% to 95.7%) and 100% (CI, 99.3% to 100%), respectively. For the HIV RNA assay, sensitivity was 100% and specificity was 97.4% (CI, 94.9% to 98.9%). Fever, myalgia, rash, night sweats, and arthralgia occurred more frequently in patients with primary infection (P < 0.05).


CONCLUSIONS
No sign or symptom allows targeted screening for primary infection. Although assays for HIV RNA are more sensitive than those for p24 antigen in diagnosing primary infection, they are more expensive and are more likely to yield false-positive results.
Daar
E S
ES
Cedars-Sinai Burns & Allen Research Institute, University of California, Los Angeles, USA. Daar@CSHS.org
Little
S
S
Pitt
J
J
Santangelo
J
J
Ho
P
P
Harawa
N
N
Kerndt
P
P
Glorgi
J V
JV
Bai
J
J
Gaut
P
P
Richman
D D
DD
Mandel
S
S
Nichols
S
S
D000914:Antibodies, Viral / Q000097:blood; D015153:Blotting, Western; D005189:False Positive Reactions; D005260:Female; D016655:HIV Core Protein p24 / Q000097:blood; D015658:HIV Infections / Q000175:diagnosis*; D015497:HIV-1 / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012680:Sensitivity and Specificity; D019562:Viral Load
D000914:Antibodies, Viral; D016655:HIV Core Protein p24; D012367:RNA, Viral