Talking about "Clinical Symptoms" and the Diagnosis of Serology for HIV and evaluating Immune window is waste of time
Non-specific and non-serious symptoms were found in studies and did not assist in the diagnosis of HIV infection or as a marker of immunological window.
In clinical practice, the detection of HIV infection - considered the most common stage of the infectious disease - is proving to be difficult to diagnose as reported by the researchers.
A Immune window is the golden rule and must be respected. And accepted by the people who pass through it ....
Even in a prospective cohort study whose high-risk participants were closely monitored.
Those who have contracted the virus rarely show any signs or acute clinical symptoms that indicate the presence of HIV.
Assin informedMerlin Robb, MDAnd colleagues from the Military Research Program in US HIV in Bethesda, Maryland.
"During the acute phase and identification of HIV cases based on clinical criteria can be difficult," concluded Robb, and colleagues, in the online edition ofNew England Journal of Medicine.
The acute disease is characterizedThe presence of HIV RNA or the call of p24 antigen, but the absence of anti-HIV antibodies.
It was believed that this phase could be associated, in many cases,with serious clinical symptoms of flu ignoring the immune window.
Detection of HIV infection in the acute phase would be important for several reasons, according to Robb and colleagues. First, patients are potentially more infectious in the acute phase, and with a rapid diagnosis, treatment with antiretroviral and behavioral modification would be allowed to disrupt the later transmission chain.
Well, there is some evidence thatthe so-called viral reservoir- One infected cell pool that is not affected by antiretroviral therapy in later stages - can be reduced in size or even prevented from establishing the immediate start of Antiretroviral therapy during the acute phase.
Defining HIV infection based on "clinical symptoms" is a sad and painful path for people who fear the disease.
And there is evidence thatEarly treatment may allow patients later could control HIV infection without the use of antiretroviral drugs.
This is not yet proven
To characterize the acute phase more clearly, Robb Report and colleagues are conducting a prospective study of natural history - the dubbed RV 217 - in Uganda, Kenya, Tanzania, and Thailand.
Analysis of Clinical Symptoms May Generate Wrong Results
It is intended to conduct an even more rigorous analysis of how the host and virus interact during the acute phase of infection. As well as the clinical manifestations of the disease and manifestations that may occur even in the window period.
All this, shown in the chart is very non-specific and although you should seek a doctor, in the eagerness to raise the causes of these problems.
They will not always show "a sign of AIDS or, as many have said.
If you omit to suggest the doctor and say that they may be "symptoms of" seroconversion disease "they will not see it.
Taking a loan, my wife's words, she had "a flu". A truly strong flu, which she suspects would not survive, but survived.
The 2,276 participants were people at high risk for HIV infection - but not yet infected.
They were recruited from "bars, clubs and other places associated with transactional sex" in the four countries, and researchers reported.
The first part of the study involved surveillance, with volunteers giving small blood samples by measuring digital puncture and large volume blood samples from 26 to 67 ml every 6 months.
The second aspect was the analysis of what happens in the post-infection period.
Collection of small blood samples were tested for HIV RNA up to 48 hours
The small blood samples were tested for HIV RNA within 24 at 48 hours after collection.
Robb Report and colleagues reported that 261 of these individuals had initial RNA reactions and 112 had been confirmed as reagent for HIV.
Thus, confirming an overall incidence rate of 3,4%.
Of the 112s, 50 volunteers had two or more samples positive for HIV RNA before antibodies were detected.
And they were included in the virological and immunological analyzes.
It is known that the HIV viral load in the blood behaves in a way that increases considerably after infection, reaching a peak
Then eventually a fall, or rests on what is called a viral load setpoint - plateau of viremia, which persists durable in the absence of therapy.
Robb Report and colleagues have found that follows below:
- The median peak viremia was 6,7 log10HIV RNA copies per milliliter of blood and was 13 days after the first sample showed HIV nucleic acids.
- The antibodies were detected on an enzyme immunoassay occurred in an average of fourteen days after the first positive sample of viral RNA.
- The low point of viremia viremia was 4,3 log10copies per milliliter, was seen by an average of 31 days and was similar to the average viral load set point 4,4 log10copies per milliliter.
Clinical manifestations of acute HIV infection were more common in the period around the peak of viremia.
The most frequently reported symptoms were fever.
And, also, headache and malaise, while tachycardia and lymphadenopathy were among the most common signs.
However, not determinants
About 94% of the volunteers had a clinical manifestation.
With 88% reporting at least one symptom and 78% at least one signal.
Absence of Symptoms
But in 367's 518 visits that included a physical examination, participants reported no symptoms.
Signs and symptoms were most commonly reported at the study visit shortly before the peak of viremia.
An average of one for both signs and symptoms, ranging from zero to fifteen and from zero to three, respectively.
"Nonspecific symptoms and signs were more common and no serious manifestations were observed.
The volunteers reported symptoms in only 29% of visits and on any visit day the probability of observing a symptom or signal was only of 50% ".
Finding people with HIV in the acute phase is therefore "somewhat challenging" and inaccurate in a general clinical setting, they concluded.
Challenging is the erudite form of they have used str phrase, this explanation
The study was supported by the Department of Defense and the National Institute of Allergy and Infectious Diseases.
The official said there are no potential conflicts relevant to the research to be reported.
Translated by Cláudio Souza do Original
- reviewed by Perry Wilson, MD, MSCE Assistant Professor of Nephrology Section of the Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner Capacity
Last update 17 / 02 / 2018
- primary source
New England Journal of Medicine