Challenges of diagnosing acute HIV-1 subtype C infection in African women: performance of a clinical algorithm and the need for point-of-care nucleic-acid based testing.

Background. Prompt diagnosis of acute HIV infection (AHI) benefits the individual and provides opportunities for public health intervention. The aim of this study was to describe most common signs and symptoms of AHI, correlate these with early disease progression and develop a clinical algorithm to identify acute HIV cases in resource limited setting. Methods. 245 South African women at high-risk of HIV-1 were assessed for AHI and received monthly HIV-1 antibody and RNA testing. Signs and symptoms at first HIV-positive visit were compared to HIV-negative visits. Logistic regression identified clinical predictors of AHI. A model-based score was assigned to each predictor to create a risk score for every woman. Results. Twenty-eight women seroconverted after a total of 390 person-years of follow-up with an HIV incidence of 7.2/100 person-years (95%CI 4.5–9.8). Fifty-seven percent reported ≥1 sign or symptom at the AHI visit. Factors predictive of AHI included age <25 years (OR = 3.2; 1.4–7.1), rash (OR = 6.1; 2.4–15.4), sore throat (OR = 2.7; 1.0–7.6), weight loss (OR = 4.4; 1.5–13.4), genital ulcers (OR = 8.0; 1.6–39.5) and vaginal discharge (OR = 5.4; 1.6–18.4). A risk score of 2 correctly predicted AHI in 50.0% of cases. The number of signs and symptoms correlated with higher HIV-1 RNA at diagnosis (r = 0.63; p<0.001). Conclusions. Accurate recognition of signs and symptoms of AHI is critical for early diagnosis of HIV infection. Our algorithm may assist in risk-stratifying individuals for AHI, especially in resource-limited settings where there is no routine testing for AHI. Independent validation of the algorithm on another cohort is needed to assess its utility further. Point-of-care antigen or viral load technology is required, however, to detect asymptomatic, antibody negative cases enabling early interventions and prevention of transmission

New-Onset Cervical Lymphadenopathy in a Patient Undergoing Treatment of Pulmonary Mycobacterium avium Complex Infection: Toxoplasmosis Lymphadenitis

Immunocompetent hosts with toxoplasmosis are usually asymptomatic. However, T. gondii can present as an acute systemic infection. Symptomatic patients usually have a benign, self-limited course that typically lasts from a few weeks to months. Herein, we present a 66-year-old immunocompetent female who developed dysphagia and new-onset cervical lymphadenopathy during pulmonary Mycobacterium avium complex treatment

A nasal hypertrophic lesion as a presentation of herpes simplex virus

Herpes simplex virus type 1 and type 2 (HSV-1 & HSV-2) are one of the leading causes of ulcer and blister lesions worldwide. These infections are latent with recurrences but many people may have a seropositive antibody yet remain asymptomatic. Although HSV presenting with hypertrophic lesions have been reported in the literature at urogenital, lung, and conjunctival sites, we describe a case of a mass lesion in the nasal cavity of a 46 year-old female with a history of human immunodeficiency virus (HIV). The patient presented initially with nasal congestion and subsequently developed facial edema. The mass lesion regressed after one month of treatment with valacyclovir. Keywords: Nasal hypertrophic lesion, Nasal pseudotumor, Herpes simplex virus, Human immunodeficiency viru

Signs and symptoms associated with acute HIV infection.

*<p>Odds Ratio adjusted for repeated measures.</p><p>Note: Signs and symptoms reported with <5% frequency in the AHI cases or p>0.15 were omitted. These included splenomegaly, anal ulcers, swollen joints, gingivitis, observed fever, aseptic meningitis, peripheral neuropathy, conjunctivitis, hepatomegaly, photophobia, parasthaesia, retro-orbital headache and neck stiffness.</p

Unadjusted and adjusted analysis of signs and symptoms associated with acute HIV Infection.

*<p>Model for behavioural and demographic factors adjusted for age in years, relationship status, education and age at sexual debut (data not shown), while model for symptoms and signs adjusted for sore throat, rash, loss of appetite, weight loss, genital ulcers and vaginal discharge.</p>**<p>Risk score model adjusting for age, sore throat, rash, loss of appetite, weight loss, genital ulcers and vaginal discharge.</p

Baseline demographic and behavioural characteristics of South African women at high risk of HIV acquisition stratified by HIV status [25].

#<p>Acute HIV Infection.</p

Sensitivity and Specificity for different number of signs and symptoms.

*<p>POCT: point of care test.</p

Signs and symptoms according to HIV diagnostic test.

*<p>Fisher’s Exact test.</p