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1 February 2007

Volume 195, Number 3
The Journal of Infectious Diseases 2007;195:416–424
© 2006 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2007/19503-0016$15.00
DOI: 10.1086/510755
MAJOR ARTICLE

Rapid, Real‐Time Detection of Acute HIV Infection in Patients in Africa

Susan A. Fiscus,1

Christopher D. Pilcher,2

William C. Miller,2,3

Kimberly A. Powers,3

Irving F. Hoffman,2

Matthew Price,3,a

David A. Chilongozi,4

Clement Mapanje,4

Robert Krysiak,2

Syze Gama,4

Francis E. A. Martinson,4

Myron S. Cohen,1,2 and the

Malawi–University of North Carolina Project Acute HIV Infection Study Teamb

Departments of 1Microbiology and Immunology, 2Medicine, and 3Epidemiology, University of North Carolina (UNC) at Chapel Hill, Chapel Hill; 4UNC Project, Lilongwe Central Hospital, Lilongwe, Malawi

Background.We conducted a prospective study to evaluate methods of detecting clients with sexually transmitted diseases (STDs) who were acutely coinfected with human immunodeficiency virus (HIV) in Lilongwe, Malawi.

Methods.After informed consent was obtained, all clients with acute STDs were offered voluntary HIV counseling and testing by 2 rapid antibody tests. Samples from rapid test–negative or –discordant subjects were pooled (50:5:1) and tested for HIV RNA. Western blots were performed on all rapid test–discordant specimens with detectable HIV RNA. A subset of specimens received p24 antigen testing with standard and/or ultrasensitive methods. Patients with possible acute HIV infection were followed to confirm seroconversion.

Results.A total of 1450 clients (34% female and 66% male) agreed to testing, of whom 588 (40.55%) had established HIV infection and 21 (1.45%) had acute infection. Discordant rapid antibody tests identified 7 of 21 (33.3% sensitivity), standard p24 antigen identified 12 of 16 (75% sensitivity), and ultrasensitive p24 antigen identified 15 of 17 (88% sensitivity) acute cases. By definition, the sensitivity of the RNA assay was 100%.

Conclusions.Real‐time pooled RNA testing for the detection of acute HIV infection is feasible in resource‐limited settings. However, parallel rapid testing and p24 antigen testing are technologically simpler and together may detect 90% of acute cases.

Received 1 June 2006; accepted 22 September 2006; electronically published 22 December 2006.

Reprints or correspondence: Dr. Susan A. Fiscus, Dept. of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599‐7290 ().

Cited by

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Online publication date: 1-Feb-2009.
Abstract-Full Text-PDF Version (135 kB)
A. Ren, B. Louie, L. Rauch, L. Castro, S. Liska, J. D. Klausner, M. W. Pandori. (2008) Screening and confirmation of human immunodeficiency virus type 1 infection solely by detection of RNA. Journal of Medical Microbiology 57:10, 1228-1233
Online publication date: 1-Nov-2008.
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Cynthia L. Gay, Myron S. Cohen. (2008) Antiretrovirals to prevent HIV infection: Pre-and postexposure prophylaxis. Current Infectious Disease Reports 10:4, 323-331
Online publication date: 1-Aug-2008.
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Raúl Ortiz de Lejarazu, Vincent Soriano, José M. Eiros, Manuel Arias, and Carlos Toro. (2008) HIV‐1 Infection in Persistently HIV‐1–Seronegative Individuals: More Reasons for HIV RNA Screening. Clinical Infectious Diseases 46:5, 785-785
Online publication date: 1-Mar-2008.
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Linda Gelgor, John Kaldor. (2008) Epidemiology of primary HIV-1 infection. Current Opinion in HIV and AIDS 3:1, 4-9
Online publication date: 1-Feb-2008.
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Eric S Daar, Christopher D Pilcher, Frederick M Hecht. (2008) Clinical presentation and diagnosis of primary HIV-1 infection. Current Opinion in HIV and AIDS 3:1, 10-15
Online publication date: 1-Feb-2008.
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Kimberly A Powers, William C Miller, Christopher D Pilcher, Clement Mapanje, Francis EA Martinson, Susan A Fiscus, David A Chilongozi, David Namakhwa, Matthew A Price, Shannon R Galvin, Irving F Hoffman, Myron S Cohen. (2007) Improved detection of acute HIV-1 infection in sub-Saharan Africa: development of a risk score algorithm. AIDS 21:16, 2237-2242
Online publication date: 1-Nov-2007.
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Rachel Smith, Nicola M Zetola, Jeffrey D Klausner. (2007) Beyond the end of exceptionalism: integrating HIV testing into routine medical care and HIV prevention. Expert Review of Anti-infective Therapy 5:4, 581-589
Online publication date: 1-Sep-2007.
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David M. Margolis and Nancie M. Archin. (2007) Eliminating Persistent HIV Infection: Getting to the End of the Rainbow. The Journal of Infectious Diseases 195:12, 1734-1736
Online publication date: 15-Jun-2007.
Citation-Full Text-PDF Version (144 kB)

  • Potential conflicts of interest: none reported.

    Presented in part: 2nd International Workshop on Acute HIV Infection, Washington, DC, 4–5 May 2004 (abstract T‐04); 12th Conference on Retroviruses and Opportunistic Infections, Boston, MA, February 22–26, 2005 (abstract 20).

    Financial support: National Institutes of Health (grants R37 DK49381, 5 P30 AI50410, 5U19 AI031496, K23 AI01781, R01 MH68686, and ST32 AI07701‐29).

  • Present affiliation: International AIDS Vaccine Initiative, New York, New York.

  • Other study team members are listed after the text.

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