title: Prevalence of seroconversion symptoms and relationship to set-point viral load:  findings from a subtype C epidemic, 1995-2009.
abstract: OBJECTIVE
  To describe symptoms, physical examination findings, and set-point viral load associated with acute HIV seroconversion in a heterosexual cohort of HIV-discordant couples in Zambia.
  
  
  METHODS
  We followed HIV serodiscordant couples in Lusaka, Zambia from 1995 to 2009 with HIV testing of negative partners and symptom inventories 3 monthly, and physical examinations annually.
  
  
  METHODS
  We compared prevalence of self-reported or treated symptoms (malaria syndrome, chronic diarrhea, asthenia, night sweats, and oral candidiasis) and annual physical examination findings (unilateral or bilateral neck, axillary, or inguinal adenopathy; and dermatosis) in seroconverting vs. HIV-negative or HIV-positive intervals, controlling for repeated observations, age, and sex. A composite score comprised of significant symptoms and physical examination findings predictive of seroconversion vs. HIV-negative intervals was constructed. We modeled the relationship between number of symptoms and physical examination findings at seroconversion and log set-point viral load using linear regression.
  
  
  RESULTS
  Two thousand, three hundred and eighty-eight HIV-negative partners were followed for a median of 18 months; 429 seroconversions occurred. Neither symptoms nor physical examination findings were reported for most seroconverters. Seroconversion was significantly associated with malaria syndrome among nondiarrheic patients [adjusted odds ratio (aOR) = 4.0], night sweats (aOR = 1.4), and bilateral axillary (aOR = 1.6), inguinal (aOR = 2.2), and neck (aOR = 2.2) adenopathy relative to HIV-negative intervals. Median number of symptoms and findings was positively associated with set-point viral load (P < 0.001).
  
  
  CONCLUSIONS
  Although most acute and early infections were asymptomatic, malaria syndrome was more common and more severe during seroconversion. When present, symptoms and physical examination findings were nonspecific and associated with higher set-point viremia.
authors.affiliation: Emory University Rollins School of Public Health, Atlanta, Georgia 30322, USA. pssulli@emory.edu
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Sullivan
authors.forename: Ulgen
authors.initials: U
authors.lastname: Fideli
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Wall
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.forename: Cheswa
authors.initials: C
authors.lastname: Vwalika
authors.forename: William
authors.initials: W
authors.lastname: Kilembe
authors.forename: Amanda
authors.initials: A
authors.lastname: Tichacek
authors.forename: Nicole
authors.initials: N
authors.lastname: Luisi
authors.forename: Joseph
authors.initials: J
authors.lastname: Mulenga
authors.forename: Eric
authors.initials: E
authors.lastname: Hunter
authors.forename: Debrah
authors.initials: D
authors.lastname: Boeras
authors.forename: Susan
authors.initials: S
authors.lastname: Allen
mesh_terms: D000293:Adolescent; D000328:Adult; D001247:Asthenia / Q000453:epidemiology* / Q000821:virology; D002180:Candidiasis, Oral / Q000453:epidemiology* / Q000821:virology; D015331:Cohort Studies; D003967:Diarrhea / Q000453:epidemiology* / Q000821:virology; D058872:Epidemics; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000821:virology; D015497:HIV-1 / Q000276:immunology / Q000302:isolation & purification*; D020010:Heterosexuality; D006801:Humans; D016014:Linear Models; D008288:Malaria / Q000453:epidemiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012747:Sexual Partners; D019562:Viral Load; D014766:Viremia; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology
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