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Missed opportunities for identifying primary HIV within genitourinary medical/HIV services
K Sharrocks1, C B Jones, C Naftalin
1Harrison Wing, Guys and St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH.
Insights
Clinical identification of primary HIV infection (PHI) is challenging, with less than half of cases detected. Early suspicion requires awareness of risk factors and symptoms to prevent onward transmission.
Area of Science:
- Infectious Diseases
- Public Health
- Clinical Medicine
Background:
- Primary HIV infection (PHI) is a critical window for preventing onward transmission.
- Clinical identification of PHI is often missed in genitourinary medicine settings.
- The Health Protection Agency (HPA) avidity assay aids in identifying recent HIV infections.
Purpose of the Study:
- To evaluate the clinical diagnostic capabilities for primary HIV infection (PHI) across three genitourinary medicine centers.
- To identify factors associated with the clinical suspicion of PHI.
Main Methods:
- A retrospective case-note review was conducted for individuals diagnosed with HIV between January and August 2009.
- The HPA avidity assay was used to identify cases of recent HIV infection (PHI).
- Data on clinical presentation, risk factors, and diagnostic timelines were analyzed.
Main Results:
- Out of 64 identified PHI cases, only 31 (48%) were clinically identified.
- Clinical suspicion was significantly associated with unprotected anal intercourse, seroconversion symptoms, recent negative HIV tests, and avidity assay availability.
- Seventy percent of missed PHI cases had documented risk factors, and only 35% of identified PHI cases were informed about enhanced infectivity.
Conclusions:
- Clinical suspicion of PHI remains low despite available risk factors and diagnostic tools.
- There is a need to improve the clinical recognition of PHI to reduce transmission.
- Enhanced patient counseling regarding infectivity is crucial for preventing secondary spread.
Abstract:
To assess the ability of three genitourinary medical centres to clinically identify primary HIV infection (PHI). Cases of recently acquired HIV infection, identified using the Health Protection Agency (HPA) avidity assay on all HIV diagnoses from January to August 2009, were investigated by case-note review. Sixty-four individuals were identified as PHI using the HPA avidity assay. Of 64 individuals, 31 (48%) were identified clinically. Imperial College identified 8/26 (31%), Guys and St Thomas' 15/27 (56%) and Brighton 8/11 (73%). Clinical suspicion of PHI was associated with reported unprotected anal intercourse (P = 0.017), seroconversion symptoms (P = 0.0004), a negative HIV test within six months (P = 0.024) and avidity assay result availability (P = 0.0169). Seventy percent of PHI cases missed had a documented risk factor. Thirty-five percent of those clinically identified with PHI were documented as informed of the associated enhanced infectivity. Suspicion of PHI was low despite documented risk factors and recent HIV-negative antibody tests. Counselling to prevent onward transmission was suboptimal.
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