Try to Know If You Have HIV Talking about “Clinical Symptoms” and Diagnosis of HIV Serology
Nonspecific and non-serious symptoms have been found in studies and have not helped in the diagnosis of HIV infection or as a marker of window period
Even in a prospective cohort study whose high-risk participants were closely monitored, those who contracted the virus rarely show any signs or acute clinical symptoms that indicate 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 the identification of HIV cases on the basis of clinical criteria can be difficult", concluded Robb, and colleagues, in the online edition of New England Journal of Medicine.
The acute phase of the 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 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 rapid diagnosis, antiretroviral treatment and behavioral modification would be allowed to interrupt the posterior transmission chain.
Defining HIV infection based on “Clinical symptoms” is a sad way
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 - can be reduced in size or even prevented from establishing itself by immediately starting 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 study of natural history - the dubbed RV 217 - in Uganda, Kenya, Tanzania, and Thailand.
Clinical analyzes can generate misleading results
It is intended to carry out 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 locations 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 of blood samples from 26 to 67 ml every 6 months. The second aspect was the analysis of what happens in the period after infection.
Collection of small blood samples were tested for HIV RNA within 48 hours
Small blood samples were tested for HIV RNA within 24 to 48 hours after collection.
Robb Report and colleagues reported that 261 of these people had initial RNA reactions and 112 had been confirmed as a reagent for HIV, confirming an overall incidence rate of 3,4%.
Of the 112, 50 volunteers had two or more HIV RNA positive samples before antibodies were detected and were included in the virological and immunological analysis.
The level of HIV viral load in the blood is known to behave in a way that increases considerably after infection, reaching a peak and then eventually falling, or is based on what is called the load setpoint viral - viremia plateau, which persists 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 an average of fourteen days after the first positive viral RNA sample.
- The low viral load viral level was 4,3 log10copies per milliliter, was seen at an average of 31 days and was similar to the average viral load setpoint of 4,4 log10 copies per milliliter.
The 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 sign, but in 367 518 visits that included a physical examination, participants reported absence of symptomsparticipants reported no symptoms.
Signs and symptoms were most commonly reported at the study visit just before the peak of viremia - an average of one for both signs and symptoms, ranging from zero to fifteen and zero to three, respectively with variation from zero to fifteen and from zero to three, respectively.
"Nonspecific symptoms and signs were more common and no serious manifestations were observed, the volunteers reported symptoms in only 29% of visits and on any day of visit the probability of observing a symptom or sign was only 50%", the researchers summarized.
Finding people with HIV in the acute phase is therefore "challenging" and inaccurate in a general practice setting, they concluded.
The study was supported by the Department of Defense and the National Institute of Allergy and Infectious Diseases. The official said 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 and Dorothy Caputo Medical School, MA, BSN, RN, Nurse Capacity Planner
Last updated 07.03.2019
- primary source
New England Medical Officer
Trying to know if you have HIV based on symptoms reminds me of a conversation with Chicão, a friend, a real friend, from other times. It is an old conversation, still valid….
We talked about AIDS and about the absolute lack of will we had to take the exam because, for us, in the second half of the 80, the twentieth century.
That's because there is no damn FDP that convinces me that the expression “1980s is correct”, and “not knowing if you had AIDS, in those times, it was a blessing. Today, and it was a blessing to know it, because it is easier to treat.
Test yourself periodically, and especially after the 2019 carnival. Or any other.
And we're still talking about the guy who left the Square Wagon, after having been with that sculptural creature.
A fairy, and a fuck, that was all!
Then, he passed the cafeteria, at half past six in the morning, entered, with a smile on his face and found a clerk "P" for life and ordered an orange juice.
It was a cold joint, for it was all that was left of his money. Rsrs.
The clerk does not even look at the oranges (did anyone mention oranges?) And grind them.
Only one of them was kind of passing by and when the citizen wakes up, four or five hours later he sees on TV that “diarrhea is a symptom of AIDS".
You see, it could be, but it's not quite like that!
Fifteen minutes later, the pressed orange makes its first attack and, in the bathroom, an unexpected spray from the unlikely spotunexpected spray coming from unlikely location.
And he thinks, silly and terrified:
MY GOD! I'M WITH AIDS.
It could even be, but in other circumstances, and that is why we say:
Test For HIV
At the top of this website is written: “There is life with HIV” !. And there is. Or I Wouldn't Say It!