Researchers from Johns Hopkins and India find that a simple set of symptoms including fever, joint pain, and night sweats can quickly identify people who recently have been infected with the AIDS virus, even before there is evidence from a blood test. Unprotected sex with a prostitute and a fresh genital ulcer also are tip-offs to recent HIV infection.
The findings, published in the Dec. 17, 1997 issue of the Journal of the American Medical Association are important because people in the very early, "acute," phase of HIV infection have not yet produced HIV antibodies, which are the proteins that show up in AIDS blood tests. Thus, the tests can be negative, even if the person is infected.
In the current Indian study -- the largest of acutely infected people in the world -- the investigators compared antibody test evidence with simple clinical signs to see which signs were present even when the antibody test was negative. The team, which included researchers from the National AIDS Research Institute of India, screened a group of patients in two sexually transmitted disease clinics in Pune, India, for an HIV protein called p24 antigen. Having p24 antigen is proof of HIV infection.
"We were able to show that certain symptoms tended to appear in people who had p24 even before they had a positive antibody test," said Robert C. Bollinger, associate professor of medicine. The study was supported by the National Institutes of Health and the National Institute of Allergy and Infectious Diseases.
"Those with a recent history of joint pain were more than six times more likely to test positive for p24 antigen," Bollinger says, "and those with a recent history of night sweats had a ninefold increase in the risk of testing positive. Also, patients who did not test positive for antibodies but did report fever within the last three months were five times more likely to test positive for p24 antigen than those without a recent history of fever."
The study's results conflict with previous findings that up to 90 percent of people acutely infected with HIV have certain "unique" symptoms, such as swollen lymph glands, sore throat and oral thrush. The present study found only 47 percent of individuals infected with HIV have such symptoms.
The researchers conducted the study between May 1993 and June 1996. Among a total of 3,874 patients, 58 (1.5 percent) had p24 antigen on the first visit and most of these individuals (88 percent) were men.
Thirty-nine (77 percent) of the 51 men who were p24-positive reported having sex with a prostitute, while 131 (51 percent) of 255 control men did so. Active genital ulcers were found in 46 (79 percent) of the 58 p24-positive men and women, compared with 137 (47 percent) of the 290 control patients.
The World Health Organization estimates that India has more than five million HIV-infected persons and may face the largest burden of HIV infection of any country in the world by the end of this decade.
Other authors of the study include Sanjay M. Mehendale, Ramesh S. Paranjape and Deepak A. Gadkari (The National AIDS Research Institute, Pune, India); Ronald S. Brookmeyer, and Mary E. Shepherd (Johns Hopkins); and Thomas C. Quinn (Johns Hopkins and The National Institute of Allergy and Infectious Diseases, Bethesda, Md).
Materials provided by Johns Hopkins Medical Institutions. Note: Content may be edited for style and length.
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