Diagnosis of primary HIV-1 infection
ES Daar, S Little, J Pitt, J Santangelo, P Ho… - Annals of internal …, 2001 - acpjournals.org
Annals of internal medicine, 2001•acpjournals.org
Background: The optimal approach for diagnosing primary HIV-1 infection has not been
defined. Objective: To determine the usefulness of symptoms and virologic tests for
diagnosing primary HIV-1 infection. Design: Prospective cohort study. Setting: A teaching
hospital in Los Angeles and a university research center in San Diego, California. Patients:
436 patients who had symptoms consistent with primary HIV infection. Measurements:
Clinical information and levels of HIV antibody, HIV RNA, and p24 antigen. Results: Primary …
defined. Objective: To determine the usefulness of symptoms and virologic tests for
diagnosing primary HIV-1 infection. Design: Prospective cohort study. Setting: A teaching
hospital in Los Angeles and a university research center in San Diego, California. Patients:
436 patients who had symptoms consistent with primary HIV infection. Measurements:
Clinical information and levels of HIV antibody, HIV RNA, and p24 antigen. Results: Primary …
Background
The optimal approach for diagnosing primary HIV-1 infection has not been defined.
Objective
To determine the usefulness of symptoms and virologic tests for diagnosing primary HIV-1 infection.
Design
Prospective cohort study.
Setting
A teaching hospital in Los Angeles and a university research center in San Diego, California.
Patients
436 patients who had symptoms consistent with primary HIV infection.
Measurements
Clinical information and levels of HIV antibody, HIV RNA, and p24 antigen.
Results
Primary infection was diagnosed in 54 patients (12.4%). The sensitivity and specificity of the p24 antigen assay were 88.7% (95% CI, 77.0% to 95.7%) and 100% (CI, 99.3% to 100%), respectively. For the HIV RNA assay, sensitivity was 100% and specificity was 97.4% (CI, 94.9% to 98.9%). Fever, myalgia, rash, night sweats, and arthralgia occurred more frequently in patients with primary infection (P < 0.05).
Conclusions
No sign or symptom allows targeted screening for primary infection. Although assays for HIV RNA are more sensitive than those for p24 antigen in diagnosing primary infection, they are more expensive and are more likely to yield false-positive results.
*For participants in the Los Angeles County Primary HIV Infection Recruitment Network, see Appendix.
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