title: Acute HIV-1 infection is as common as malaria in young febrile adults seeking care in coastal Kenya.
abstract: BACKGROUND
  Febrile adults are usually not tested for acute HIV-1 infection (AHI) in Africa. We assessed a strategy to diagnose AHI among young adult patients seeking care.
  
  
  METHODS
  Young adults (<30 years) who met predefined AHI criteria at care seeking, including fever, sexually transmitted disease symptoms, diarrhoea, body pains or multiple partners were referred from five pharmacies and screened at five health facilities. Prevalent HIV-1 was diagnosed by nationally recommended serial rapid HIV-1 testing. Willing HIV-1-negative patients were evaluated for AHI, defined as a positive p24 antigen test, and subsequent seroconversion or RNA detection. Febrile patients evaluated for AHI were also screened for malaria using a rapid test, with PCR confirmation of positives.
  
  
  RESULTS
  In 3602 adults seeking care, overall HIV-1 prevalence was 3.9%: 7.6% (68/897) among patients meeting AHI criteria vs. 2.6% (71/2705) among those who did not (P < 0.001). AHI was diagnosed in five of 506 HIV-1-negative or discordant patients who met AHI risk criteria and were completely evaluated [prevalence 1.0%, 95% confidence interval (CI) 0.3-2.3%]. Of these five AHI cases, four were diagnosed among the 241 patients with fever (prevalence 1.7%, 95% CI 0.5-4.2%), vs. one among 265 non-febrile patients (prevalence 0.4%, 95% CI 0.0-2.0%, P = 0.1). Malaria was confirmed by PCR in four (1.7%) of the 241 febrile patients.
  
  
  CONCLUSIONS
  AHI was as common as confirmed malaria in young febrile adults seeking care. An AHI detection strategy targeting young febrile adults seeking care at pharmacies and health facilities is feasible and should be considered as an HIV-prevention strategy in high-transmission settings.
authors.affiliation: aCentre for Geographic Medicine Research - Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya bNuffield Department of Clinical Medicine, University of Oxford, Headington, UK cCounty Health Office, Kilifi, Kenya dNuffield Department of Population Health, University of Oxford, Headington, UK eUniversity of Nairobi, Nairobi, Kenya fUniversity of Washington, Seattle, Washington, USA. *Peter Mugo and Henrieke A.B. Prins contributed equally to the writing of this article.
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
authors.forename: Peter
authors.initials: P
authors.lastname: Mugo
authors.forename: Henrieke A B
authors.initials: HA
authors.lastname: Prins
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wahome
authors.forename: Alexander N
authors.initials: AN
authors.lastname: Thiong'o
authors.forename: Grace
authors.initials: G
authors.lastname: Mwashigadi
authors.forename: Elisabeth M
authors.initials: EM
authors.lastname: van der Elst
authors.forename: Anisa
authors.initials: A
authors.lastname: Omar
authors.forename: Adrian D
authors.initials: AD
authors.lastname: Smith
authors.forename: Susan M
authors.initials: SM
authors.lastname: Graham
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005334:Fever / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D015995:Prevalence; D055815:Young Adult