Acute HIV-1 infection is highly prevalent in Ugandan adults with suspected malaria

Abstract

Objectives Acute febrile illnesses consistent with malaria are the most common presentation at health clinics in sub-Saharan Africa, accounting for 30–50% of outpatient visits. The symptoms of acute human immunodeficiency virus (HIV) infection can mimic acute malaria. We investigated whether acute HIV infections could be identified among adults with suspected malaria at rural health centers in Uganda. Design Cross-sectional study of 1,000 consecutive patients referred for malaria blood smears at each of 7 government health centers, of which 2893 (41%) were age 13 years or older and tested for HIV. Methods HIV EIA antibody testing was performed on dried blood spots and confirmed by Western blot (WB). EIA non-reactive and EIA reactive, WB-unconfirmed samples were pooled (10/pool) and tested for HIV RNA by nucleic acid amplification testing. We defined acute HIV infection as HIV-1 RNA positive with a negative or indeterminate HIV-1 Western blot pattern and early HIV infection as HIV-1 RNA positive with a positive Western blot pattern, but with a BED corrected optical density (ODn) of <0.8. Results Of 2893 patients evaluated, 324 (11%) had test results indicating HIV infection. Overall, 30 patients (1.0%) had acute HIV infection, 56 (1.8%) had early HIV infection, and 238 (8%) had established HIV infection. Acute HIV infections were more prevalent at sites with higher HIV prevalence and lower malaria endemicity. Conclusions At multiple sites in Uganda, 1–3% of adults with suspected malaria had acute or early HIV infection. These findings highlight a major opportunity for expanding recognition of acute and early HIV infection in Africa.

Detection of human immunodeficiency virus among individuals presenting with febrile illness in Lagos, Nigeria

“…This finding shows that the burden of HIV infection in Nigeria is still a cause for concern particularly among febrile individuals seeking healthcare at various hospitals. Our finding among these febrile participants was similar to the study by Bebell et al [13] who reported a similar prevalence of HIV among adults who sought care for suspected malaria in Uganda. Likewise, and also in 2010, Serna-Bolea et al [20] reported that 3.3% of patients who sought care for fever at a district hospital in Southern Mozambique had acute HIV infection.…”

“…Furthermore, Bebell et al reported in 2010, that 1-3% of adults who sought care for suspected malaria in Uganda actually had acute or early HIV infection [13] . Considering the surge in HIV-1 replication and viral load in individuals with ARS, who are highly contagious and the fact that such persons may not be aware of their status.…”

A Cytokine Pattern That Differentiates Preseroconversion From Postseroconversion Phases of Primary HIV Infection

“…Patients are often asymptomatic or experience a nonspecific febrile illness; a diagnostic dilemma compounded in the African setting by a significant symptom overlap with malaria. 3,9 To diagnose AHI, the presence of the virus itself must be detected by nucleic acids or proteins in the absence of HIV-specific antibodies. Fourth-generation HIV assays have demonstrated good sensitivity and specificity for detecting HIV infection and AHI but remain less sensitive than nucleic acid amplification technology.…”

Characterization of the OSSN Microbiome in HIV-1 Infected Patients

“…In a recent study Anastos et al reported higher risk in CIN3+ HIV+ women in Rwanda who had recently acquired the malaria parasite (Anastos et al, 2010). Co-infection with malaria in HIV-1 patients dysregulates the immune system (Bebell, Pilcher, Dorsey, et al, 2010). Bebell et al observed that acute HIV-1 infections occurred in high HIV prevalence regions of Uganda with low malaria endemicity (Bebell et al, 2010).…”

“…Co-infection with malaria in HIV-1 patients dysregulates the immune system (Bebell, Pilcher, Dorsey, et al, 2010). Bebell et al observed that acute HIV-1 infections occurred in high HIV prevalence regions of Uganda with low malaria endemicity (Bebell et al, 2010). Kelly and Rickinson in their review of Burkitt's lymphoma pathogenesis emphasized the significance of HIV-1 and malaria (Kelly & Rickinson, 2007).…”