title: Improved detection of acute HIV-1 infection in sub-Saharan Africa: development of a risk score algorithm.
abstract: OBJECTIVE
  Individuals with acute (preseroconversion) HIV infection (AHI) are important in the spread of HIV. The identification of AHI requires the detection of viral proteins or nucleic acids with techniques that are often unaffordable for routine use. To facilitate the efficient use of these tests, we sought to develop a risk score algorithm for identifying likely AHI cases and targeting the tests towards those individuals.
  
  
  METHODS
  A cross-sectional study of 1448 adults attending a sexually transmitted infections (STI) clinic in Malawi.
  
  
  METHODS
  Using logistic regression, we identified risk behaviors, symptoms, HIV rapid test results, and STI syndromes that were predictive of AHI. We assigned a model-based score to each predictor and calculated a risk score for each participant.
  
  
  RESULTS
  Twenty-one participants (1.45%) had AHI, 588 had established HIV infection, and 839 were HIV-negative. AHI was strongly associated with discordant rapid HIV tests and genital ulcer disease (GUD). The algorithm also included diarrhea, more than one sexual partner in 2 months, body ache, and fever. Corresponding predictor scores were 1 for fever, body ache, and more than one partner; 2 for diarrhea and GUD; and 4 for discordant rapid tests. A risk score of 2 or greater was 95.2% sensitive and 60.5% specific in detecting AHI.
  
  
  CONCLUSIONS
  Using this algorithm, we could identify 95% of AHI cases by performing nucleic acid or protein tests in only 40% of patients. Risk score algorithms could enable rapid, reliable AHI detection in resource-limited settings.
authors: Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina 27599-7435, USA. powersk@email.unc.edu
authors: Kimberly A
authors: KA
authors: Powers
authors: William C
authors: WC
authors: Miller
authors: Christopher D
authors: CD
authors: Pilcher
authors: Clement
authors: C
authors: Mapanje
authors: Francis E A
authors: FE
authors: Martinson
authors: Susan A
authors: SA
authors: Fiscus
authors: David A
authors: DA
authors: Chilongozi
authors: David
authors: D
authors: Namakhwa
authors: Matthew A
authors: MA
authors: Price
authors: Shannon R
authors: SR
authors: Galvin
authors: Irving F
authors: IF
authors: Hoffman
authors: Myron S
authors: MS
authors: Cohen
mesh_terms: D015492:AIDS Serodiagnosis; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000465:Algorithms; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000821:virology; D005260:Female; D005334:Fever / Q000821:virology; D005831:Genital Diseases, Female / Q000821:virology; D005832:Genital Diseases, Male / Q000821:virology; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis*; D015497:HIV-1; D006801:Humans; D008295:Malawi; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012725:Sexual Behavior; D012747:Sexual Partners; D012883:Skin Ulcer / Q000821:virology