The development and utility of a clinical algorithm to predict early HIV-1 infection.
The association between self-reported clinical factors and recent HIV-1 seroconversion was evaluated in a prospective cohort of 4652 high-risk participants in the HIV Network for Prevention Trials (HIVNET) Vaccine Preparedness Study. Eighty-six individuals seroconverted, with an overall annual seroconversion rate of 1.3 per 100 person-years. Four self-reported clinical factors were significantly associated with HIV-1 seroconversion in multivariate analyses: recent history of chlamydia infection or gonorrhea, recent fever or night sweats, belief of recent HIV exposure, and recent illness lasting > or =3 days. Two scoring systems, based on the presence of either 4 or 11 clinical factors, were developed. Sensitivity ranged from 2.3% (with a positive predictive value of 12.5%) to 72.1% (with a positive predictive value of 1%). Seroconversion rates were directly associated with the number of these clinical factors. The use of scoring systems comprised of clinical factors may aid in detecting early and acute HIV-1 infection in vaccine and microbicide trials. Organizers can educate high-risk trial participants to return for testing during interim visits if they develop these clinical factors. Studying individuals during early and acute HIV-1 infection would allow scientists to investigate the impact of the intervention being studied on early transmission or pathogenesis of HIV-1 infection.
Sharghi
Neda
N
Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA 02115, USA. nsharghi@hsph.harvard.edu
Bosch
Ronald J
RJ
Mayer
Kenneth
K
Essex
Max
M
Seage
George R
GR
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002690:Chlamydia Infections; D005260:Female; D005334:Fever; D005544:Forecasting; D006069:Gonorrhea; D015658:HIV Infections / Q000503:physiopathology*; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D013546:Sweating