title: High prevalence of symptomatic acute HIV infection in an outpatient ward in southern Mozambique: identification and follow-up.
abstract: OBJECTIVE
  To determine the prevalence of acute HIV infection (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
  This is a prospective observational study.
  
  
  METHODS
  Three hundred and forty-six adults presenting with reported fever at an outpatient ward at the Manhiça District Hospital in Mozambique were screened for AHI by HIV rapid serology testing, followed by HIV-RNA testing in HIV-seronegative individuals. Plasma from HIV-seronegative patients was pooled in the ratio of 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 and assessment of HIV-RNA, CD4 cell counts and percentage of activated CD8 T cells.
  
  
  RESULTS
  HIV serotesting revealed that 37.8% (95% confidence interval 32.7-43.2) of the adults had previously undiagnosed established HIV infection. Among the HIV-seronegative patients, 3.3% (95% confidence interval 1.3-6.7) were found to have AHI as demonstrated by positive HIV-1 RNA testing. Median HIV-1 RNA levels at diagnosis of AHI were 6.21 log10 copies/ml (interquartile range 5.92-6.41) and significantly higher than median HIV-RNA load at 4 months. At day 7 after screening, patients showed a median CD4 cell count of 384 cells/microl (interquartile range 239-441) and a median percentage of activated CD8 T cells of 68.4% (interquartile range 59.6-87.8).
  
  
  CONCLUSIONS
  Of patients reporting with fever, 3.3% were shown to be potentially due to AHI. 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.
authors.affiliation: Barcelona Centre for International Health Research, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universtitat de Barcelona, Barcelona, Spain.
authors.forename: Celia
authors.initials: C
authors.lastname: Serna-Bolea
authors.forename: Jose
authors.initials: J
authors.lastname: Muñoz
authors.forename: Jose M
authors.initials: JM
authors.lastname: Almeida
authors.forename: Ariel
authors.initials: A
authors.lastname: Nhacolo
authors.forename: Emilio
authors.initials: E
authors.lastname: Letang
authors.forename: Tacilta
authors.initials: T
authors.lastname: Nhampossa
authors.forename: Eliana
authors.initials: E
authors.lastname: Ferreira
authors.forename: Pedro
authors.initials: P
authors.lastname: Alonso
authors.forename: Denise
authors.initials: D
authors.lastname: Naniche
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes; D018414:CD8-Positive T-Lymphocytes; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D018023:HIV Seronegativity; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009073:Mozambique / Q000453:epidemiology; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D015995:Prevalence; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D055815:Young Adult
chemical_list: D012367:RNA, Viral