title: Does this adult patient have early HIV infection?: The Rational Clinical Examination systematic review.
abstract: OBJECTIVE
  Timely identification of human immunodeficiency virus (HIV) infection in adults can contribute to reduced mortality and likelihood of further HIV transmission. During the first 6 months after infection, known as early HIV infection, patients often report a well-described constellation of symptoms and signs. However, the literature examining utility of the clinical examination in identifying early infection has not been systematically assessed.
  
  
  OBJECTIVE
  To assess the accuracy of symptoms and signs in identifying early HIV infection among adults.
  
  
  METHODS
  We searched MEDLINE and EMBASE (1981-May, 2014) for articles investigating symptoms and signs of early HIV infection in adults and searched reference lists of retrieved articles.
  
  
  METHODS
  We retained original studies that compared symptoms and signs among patients with early HIV infection in comparison to HIV-negative individuals.
  
  
  METHODS
  Data were extracted and used to calculate sensitivity, specificity, and likelihood ratios (LRs), and meta-analysis was used to calculate summary LRs.
  
  
  RESULTS
  Of 1356 studies, 16 studies included data that were eligible for meta-analysis and included a total of 24,745 patients and 1253 cases of early HIV infection. Symptoms that increased the likelihood of early HIV infection the most included genital ulcers (LR, 5.4; 95% CI, 2.5-12), weight loss (LR, 4.7; 95% CI, 2.1-7.2), vomiting (LR, 4.6; 95% CI, 2.5-8.0), and swollen lymph nodes (LR, 4.6; 95% CI, 1.3-8.0). No symptoms had an LR that was 0.5 or lower, but the absence of recent fever (LR, 0.74; 95% CI, 0.64-0.84) slightly decreased the likelihood of early HIV infection. The presence of lymphadenopathy on physical examination was the most useful sign (LR, 3.1; 95% CI, 1.0-5.2). No sign had an LR of 0.5 or less, but the absence of lymphadenopathy slightly decreased the likelihood of early HIV infection (LR, 0.70, 95% CI, 0.49-0.92). Using data from studies that considered combinations of findings (range of possible findings, 4-17), the summary LR for individuals with 0 findings was 0.47 (95% CI, 0.38-0.58).
  
  
  CONCLUSIONS
  The limited utility of the clinical examination to detect or rule out early HIV infection highlights the importance of routine testing for HIV infection among adults.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada2Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada2Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.affiliation: Clinical Policy Office, Fraser Health Authority, Vancouver, British Columbia, Canada.
authors.forename: Greg
authors.initials: G
authors.lastname: Rowell
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada2Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada2Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Phillips
authors.affiliation: Department of Medicine, Oregon Health and Science University, Portland5Department of Public Health-Preventive Medicine, Oregon Health and Science University, Portland.
authors.forename: P Todd
authors.initials: PT
authors.lastname: Korthuis
authors.affiliation: Durham Veterans Affairs Medical Center, Durham, North Carolina7Duke University Medical Center, Durham, North Carolina.
authors.forename: David L
authors.initials: DL
authors.lastname: Simel
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008206:Lymphatic Diseases / Q000209:etiology; D010808:Physical Examination; D014456:Ulcer / Q000209:etiology; D014839:Vomiting / Q000209:etiology; D015431:Weight Loss