1 / 18

IDIBAPS - Hospital Clínic de Barcelona Universitat de Barcelona (Spain)

IDIBAPS - Hospital Clínic de Barcelona Universitat de Barcelona (Spain). Identification of symptomatic acute and recent HIV infection in a rural area of southern Mozambique. Cèlia Serna Bolea. INTRODUCTION. ADULTS AND CHILDREN LIVING WITH HIV/AIDS IN 2007. Eastern Europe & Central Asia

novia
Download Presentation

IDIBAPS - Hospital Clínic de Barcelona Universitat de Barcelona (Spain)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. IDIBAPS - Hospital Clínic de Barcelona Universitat de Barcelona (Spain) Identification of symptomatic acute and recent HIV infection in a rural area of southern Mozambique Cèlia Serna Bolea

  2. INTRODUCTION ADULTS AND CHILDREN LIVING WITH HIV/AIDS IN 2007 Eastern Europe & Central Asia 1.4 million [920 000 – 2.1 million] Western & Central Europe 610 000 [480 000 – 760 000] North America 1.0 million [540 000 – 1.6 million] East Asia 1.1 million [560 000 – 1.8 million] North Africa & Middle East 540 000 [230 000 – 1.5 million] Caribbean 440 000 [270 000 – 780 000] South & South-East Asia 7.1 million [4.4 – 10.6 million] Sub-Saharan Africa 22.5 million [20.4 – 29.4 million] Latin America 1.7 million [1.3 – 2.2 million] Oceania 35 000 [25 000 – 48 000] SSA: 68% of all HIV infections Total: 33.2 (30.6 – 36.1) million

  3. INTRODUCTION Recent infection PHASES OF HIV INFECTION Antibodies against HIV

  4. INTRODUCTION IMPORTANCE OF DETECTING ACUTE HIV INFECTION (AHI) AND RECENT INFECTION CASES • During AHI and early phases: high levels of HIV RNA (higher for subtype C)  more likely to transmit HIV infection. (Dyer JR, JID: 1998; Pilcher CD, AIDS:2007) • AHI and early months of HIV infection may contribute disproportionally to the transmission of HIV (Pilcher CD, JID: 2004; Cohen MS, JID: 2005) • 50% of onward transmissions occur in the first 6 months after infection (Brenner BG, JID: 2007)

  5. INTRODUCTION DIFFICULT DIAGNOSIS of AHI and RECENT INFECTIONS • AHI very challenging to diagnose: • Half of the patients develop non-specific flu-like or mononucleosis-like symptoms (MN) • The remaining AHI are asymptomatic and go unnoticed (Schacker T, AnInt Med 1996) Potential populations for screening in sub Saharan Africa • Sexual Transmitted Infection (STI) clinics • Voluntary Counselling and Testing centres (VCT) • Prevalence of HIV is high • Antenatal Clinics • Prevalence of HIV high and risk for mother to child transmission (MTCT) may be greater during AHI • Outpatient triage in areas of high malaria prevalence • People accustomed to presenting for fever for malaria testing

  6. OBJECTIVES • To determine prevalence of AHI within the adult HIV seronegative population presenting with reported fever to the outpatient ward. • To determine prevalence of recent HIV infection within patients with discordant/positive rapid test attending at Voluntary Counseling Testing (VCT).

  7. METHODOLOGY MANHIÇA DISTRICT STUDY SITE (in Manhiça district, Mozambique) Mozambique, southeast Africa approximately 21 million inhabitants Manhiça District Hospital (MDH) Manhiça Health Research Centre (CISM) Demographic Surveillance System (DSS) 82.000 inhabitants in 400 km2

  8. METHODOLOGY • 1) AHI group • 2) Recent Infected group Study population Study population People attending the outpatient ward with: -Fever/ reported fever -Not under followup in the HIV day hospital -HIV negative serology To assess the prevalence of acute HIV-1 infections in adults presenting with fever To assess the prevalence of recent infections in this adults presenting at VCT People attending the VCT with: -Discordant/ positive HIV serology Screening HIV RNA detection (pooling) Screening BED Incidence EIA Inclusion Inclusion HIV negativeserology HIV RNA positive Recent infected patients <6mo STUDY DESIGN Prospective Observational Study STUDY GROUPS

  9. RESULTS AHI PHASES OF HIV INFECTION Antibodies against HIV

  10. RESULTS AHI 472 subjects presenting with reported fever at outpatient ward 125 refusals 346 accepted testing 131 HIV-1 positive 215 HIV-1 negative 4 refused blood draw 211 HIV-1 negative with blood sample 209 HIV-1 RNA negative 7 HIV-1 RNA positive 1 lost to follow-up 37.8% 3.3% 6 attended followup visits

  11. RESULTS AHI AETIOLOGY of REPORTED FEVER IN HIV-SERONEGATIVE ADULTS 13% 3.3% (95% CI, 1.3-6.7) 83.7%

  12. RESULTS AHI Clinical immunological and virological features of AHI patients * Expressed as log10 copies/mL **MN=mononucleosis-like symptoms, R=respiratory, GI=gastrointestinal, P= pharyngitis, S=evidence of sexually transmitted infection (discharge, dysuria) except for ulcer, U=genital ulcer, LTFU=Lost to follow-up

  13. RESULTS RECENT Recent infection PHASES OF HIV INFECTION Antibodies against HIV

  14. RESULTS RECENT 493 subjects referred from VCT 482 HIV-1 positive 11 HIV-1 serodiscordant BED-EIA 81/493 Recent Infections 16.4%

  15. RESULTS RECENT General characteristics of recent infected patients 16.4% BED-EIA 12.6% BED-EIA CD4>200 * All values do not add up to 81 due to missing data

  16. CONCLUSIONS • High prevalence of AHI: 3.3% (95% CI, 1.3-6.7) among adults presenting with reported fever in an outpatient ward • AHI patients had high median viral load: 6.21 log10 copies/mL similar to values of AHI for subtype C in other African settings, higher than other subtypes • Percentage of activated CD8+ T lymphocytes similar to that reported in chronically HIV infected Africans • Malaria-like, mononucleosis-like symptoms and pharyngitis could be relevant syndromes to target AHI • Prevalence of undiagnosed established HIV infection in this population was 37.8% (95% CI, 32.7-43.2), higher than in previous estimations • From HIV infections diagnosed at VCT 16.4% were determined to be recent infections according to BED-EIAbut over 25% had CD4<200

  17. DISCUSSION • Screening for AHI as a novel prevention approach in areas with high HIV prevalence: • WHY? • Acute HIV is highly infectious • WHO? • Target populations: • Fever in malaria endemic areas • STI clinics • HOW? • Case finding of AHI and counseling effective for short term risk modification • Simplified HIV RNA detection methods are necessary in resource limited settings (e.g. p24 from dry blood spots) • Using BED-EIA test as an screening tool in areas with high HIV prevalence can overestimate recent infections in this population

  18. Denise Naniche Jose Muñoz Emilio Letang Pedro Alonso Jose M. Almeida Ariel Nhacolo Tacilta Nhampossa Eliana Ferreira Eusebio Macete Acknowledgments Field staff Apollinario Nzango Nelito José Elsa Banze Lucas Nhatumbo Roque Singaril Vilanculo Atanasio Chirinze

More Related