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High prevalence of acute HIV infection in Sub-Saharan Africa: a cross sectional, multi-centre screening study
Presented by Francis Martinson, Malawi.
G. Kamanga1, P. Thumbi2, M. Nkhoma3, P. Manamela4, M. Bogoshi5, M. Latka5, F. Martinson1, S.S.A. Karim2, J. Kumwenda3, H. Rees4, G. Churchyard5, M. McCauley6, C. Gay7, M.S. Cohen7
1University of North Carolina Project, Lilongwe, Malawi, University of North Carolina Project, Kamuzu Central Hospital, Lilongwe, Lilongwe, Malawi, 2CAPRISA, The Centre for AIDS Programme Research in South Africa, Durban, South Africa, 3Johns Hopkins Project, Blantyre, Malawi College of Medicine, Blantyre, Malawi, 4RHRU, University of Witwatersrand, Johannesburg, South Africa, 5Aurum Health Research, Aurum Health Research, Orkney, South Africa, 6Family Health International, Family Health International, Chapel Hill, NC, United States, 7University of North Carolina, Chapel Hill, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States
Background: Acute HIV infection (AHI) is difficult to detect as symptoms are protean and laboratory methods to detect AHI are not widely available in Africa. Prior studies in a Malawi STD clinic reported greater than 1% of HIV antibody negative subjects had unrecognized AHI.
Methods: Clients attending 2 STD clinics in Malawi and 2 STD clinics and one research facility in South Africa were screened for AHI via specimen pooling for nucleic acid test testing. AHI was defined as negative, indeterminate or discordant antibody tests with detectable HIV RNA within 45 days of study entry.
Results: To date, 6674 clients have been screened and 80 acute HIV infections have been detected for an overall AHI prevalence of 1.2%. Of 80 acutes subjects detected, 64 (80%) were enrolled on the CHAVI001 observational study. Median age was 23 years (range 18 - 42), 52% were male and median duration from screening to enrollment was 12 days. Median HIV RNA at screening was 181,000 copies/mL compared to 68,405 copies/mL at enrollment. Median CD4 cell count at enrollment was 454 (range 111 to 1580). Mean number of sexual partners reported by AHI subjects in the prior month was 1.3, and fifteen sexual partners of AHI subjects have also been enrolled on study. Only 2 (2.5%) subjects reported any social harm attributable to their AHI diagnosis, both described as personal relationship difficulties.
Conclusions: Study findings confirm a high prevalence of unrecognized, antibody negative AHI in STD clients across sub-Saharan Africa, indicating that a substantial number of highly infectious individuals with AHI are missed by standard antibody screening. Detection of individuals with AHI represents a potentially critical public health intervention to interrupt ongoing transmission. Findings suggest that STD clinics in sub-Saharan Africa are well-suited for observational, interventional and treatment studies targeted to individuals with AHI.
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