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Symptom-based score predicts acute HIV infection
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A symptom scoring method can predict acute HIV infection subsequently confirmed by testing, researchers said.
The method the researchers called the San Diego Symptom Score (SDSS) could guide clinicians on whether to test for acute HIV infection (AHI) in settings where routine testing is not normally conducted, they wrote in Clinical Infectious Diseases.
“The SDSS, a simple symptom score consisting of fever, myalgia and weight loss of 2.5 kg or greater in the 14 days prior to testing, was predictive of AHI in individuals who self-presented for community-based HIV testing,” researcher Sara Gianella, MD, an assistant professor of medicine at the University of California San Diego Center for AIDS Research, and colleagues wrote. “When selectively applied to men who have sex with men (MSM), the performance of the SDSS exceeded that reported for other risk behavior-based scores. Once validated in populations with differing demographics, the SDSS may inform allocation of resources in settings that do not routinely utilize [nucleic acid tests (NATs)] for AHI.”
The researchers noted that testing for HIV antibodies (Ab) can identify patients with an established infection but not AHI. HIV NAT testing, however, is effective at detecting AHI.
Gianella and colleagues conducted a cross-sectional analysis of a cohort study of patients tested for HIV at a community-based screening program in San Diego. They included patients who tested positive for AHI via NAT between 2007 and 2017, along with those with negative NATs in 2017. Participants indicated in a questionnaire which of 11 symptoms associated with AHI they had. The questionnaire also asked if they had experienced the symptoms in the 14 days before testing. The researchers compared the results of those who tested positive for AHI with those who tested negative.
Of 998 participants, 113 with complete symptom data had AHI, including 109 MSM.
The researchers calculated ORs for the occurrence of symptoms in patients with AHI compared with those without HIV infection. Symptoms that were significant predictors of AHI in the analysis were given point scores that corresponded with their ORs, rounded to the nearest integer. For each patient, the scores for all occurring symptoms were added up to yield an SDSS.
The occurrences of three symptoms — fever, myalgia and weight loss — were significantly higher in patients with AHI compared with those who were HIV negative (OR = 10.9, 7.8 and 4.1, respectively). Therefore, the point values for each symptom were 11, 8 and 4 points, respectively.
A score of 11 points or higher for a symptom had a sensitivity of 72%, a specificity of 96% and a diagnostic OR of 70.27, the researchers said.
Patients with AHI also reported more symptoms than those without it (a mean of 4 compared with none).
The researchers added that assessing AHI risk by symptom scoring could compensate for shortcomings in behavior-based assessments. For instance, men may fail to report sex with other men because of the stigma associated with MSM.
“These individuals misreporting their risk may fall through the cracks in settings that use risk behavior-based scores,” they wrote. “In contrast, symptoms may be less subject to stigma, and therefore individuals may be more comfortable disclosing symptoms than sexual behaviors.”– by Joe Green
Disclosures: Lin reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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