title: Most adults seek urgent healthcare when acquiring HIV-1 and are frequently treated for malaria in coastal Kenya.
abstract: BACKGROUND
  Acute HIV-1 infection (AHI) may present with symptoms for which urgent healthcare is sought. However, little is known about healthcare seeking around the time of HIV-1 seroconversion in sub-Saharan Africa.
  
  
  METHODS
  Review of clinical, counselling, treatment and laboratory records of previously HIV-1 seronegative at-risk adults, followed at monthly or 3-monthly visits, who seroconverted and enrolled in an AHI cohort. All HIV-seronegative plasma samples were tested for p24 antigen (p24) and stored preseroconversion samples for HIV-1 RNA (RNA). Factors associated with malaria treatment while acquiring HIV-1 were evaluated in multiple logistic regression.
  
  
  RESULTS
  Sixty men and 12 women (95% of 75 seroconverters) were evaluated, including 43 (60%) with either p24-positive or RNA-positive or HIV-1 discordant rapid antibodies prior to seroconversion. Prior to diagnosis, 54 patients (75%) reported fever and 50 (69%) sought urgent care for symptomatic illness, including 23 (32%) who sought care in a nonresearch setting. Twenty-nine patients (40%) received presumptive malaria treatment. Only 24% of febrile patients were tested for malaria parasites. All documented smear results were negative. Malaria treatment was strongly associated with fever [adjusted odds ratio (aOR): 46, 95% confidence interval (CI): 3-725] and nonresearch setting (aOR: 5, 95% CI: 3-64). AHI was suspected in six (12%) patients who presented for urgent care during research evaluation.
  
  
  CONCLUSIONS
  The majority of adults with AHI seek urgent healthcare. These individuals are often presumptively treated for malaria. Improved recognition of AHI in adults presenting for care may offer opportunities for optimizing HIV prevention strategies.
authors.affiliation: Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, Kilifi, Kenya. ESanders@kilifi.kemri-wellcome.org
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wahome
authors.forename: Mary
authors.initials: M
authors.lastname: Mwangome
authors.forename: Alexander N
authors.initials: AN
authors.lastname: Thiong'o
authors.forename: Haile S
authors.initials: HS
authors.lastname: Okuku
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Price
authors.forename: Lorraine
authors.initials: L
authors.lastname: Wamuyu
authors.forename: Michael
authors.initials: M
authors.lastname: Macharia
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
authors.forename: Susan M
authors.initials: SM
authors.lastname: Graham
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D006679:HIV Seropositivity / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D015497:HIV-1 / Q000187:drug effects*; D019538:Health Care Surveys; D006716:Homosexuality / Q000706:statistics & numerical data; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D011477:Sex Work / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000962:Antimalarials