Talking about "Clinical Symptoms" and HIV Serology Diagnosis
Nonspecific and non-serious symptoms were found in studies and did not aid in the diagnosis of HIV infection or as a marker of window period
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. The immunological window is the golden rule and must be respected. And accept
Even in a prospective cohort study whose high-risk participants were closely monitored, whoever contracted the virus rarely had any signs or acute clinical symptoms that indicated the presence of HIV, according to Merlin Robb, MD, And colleagues from the US Military HIV Research Program 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 of New England Journal of Medicine.
The acute phase of infection is characterized By the presence of HIV RNA or the so-called p24 antigen, but the absence of anti-HIV antibodies.
Historically, it was believed that this phase could be associated in many cases with severe flu-like symptoms that could allow doctors to detect these cases quickly.
Detection of HIV infection in the acute phase is 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.
Defining HIV infection based on "clinical symptoms" is a sad path
Well, there is some evidence that the so-called viral reservoir - a pool of infected cells that is not affected by antiretroviral therapy in later stages - may be reduced in size or even prevented from being established by the immediate onset of antiretroviral therapy during the acute phase.
And there is evidence that Early treatment may allow patients later could control HIV infection Without the use of antiretroviral drugs.
To characterize the acute phase more clearly, Robb Report and colleagues are conducting a prospective natural history study - the dubbed RV 217 - in Uganda, Kenya, Tanzania, and Thailand.
Clinical analysis may lead to misleading 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 the manifestations that may occur even in the window period.
The 2,276 participants were people at high risk for HIV infection - but not yet infected - recruited from "bars, clubs and other places associated with transactional sex" in the four countries, the 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 HIV reactant, confirming a global incidence rate of 3,4%.
Of the 112s, 50 volunteers had two or more samples positive for HIV RNA before antibodies were detected and were included in the virological and immunological analyzes.
It is known that the level of HIV viral load in the blood behaves in a way that increases considerably after infection, peaking and then eventually falling, or rests on what is called a load set point Viral - plateau of viremia, which persists durable in the absence of therapy.
Robb Report and colleagues found the following:
- The median peak viremia was 6,7 log10Copies of HIV RNA per milliliter of blood and occurred 13 days after the first sample showed HIV nucleic acids.
- Antibodies were detected in an enzyme immunoassay occurred at a mean of fourteen days after the first positive sample of viral RNA.
- The low viral load viremia was 4,3 log10Copies per milliliter, was seen on an average of 31 days and was similar to the mean of the viral load setpoint of 4,4 log10 Copies 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, headache and malaise, while tachycardia and lymphadenopathy were among the most common signs.
About 94% of the volunteers had a clinical manifestation, with 88% reporting at least one symptom and 78% at least one signal, but in 367 518 visits that included a physical examination, participants reported absence of symptoms.
Signs and symptoms were most commonly reported at the study visit shortly before the peak of viremia - a mean 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, 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%," the researchers summarized.
Finding people with HIV in the acute phase is therefore "somewhat challenging" and inaccurate in a general clinical setting, they concluded.
The study was supported by the Department of Defense and the National Institute of Allergy and Infectious Diseases. The official said that 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, Nephrology Section, Yale College of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Capacity Planner
Last updated 05.19.2016
- primary source
New England Medical Officer