Most adults seek urgent healthcare when acquiring HIV-1 and are frequently treated for malaria in coastal Kenya
Most adults seek urgent healthcare when acquiring HIV-1 and are frequently treated for malaria in coastal Kenya
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DOI：
10.1097/qad.0b013e3283474ed5
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发表时间：
2011-06-01
期刊：
影响因子：
3.8
通讯作者：
Graham, Susan M.
中科院分区：
文献类型：
--
作者：
Sanders, Eduard J.;Wahome, Elizabeth;Graham, Susan M.
背景：急性HIV-1感染（AHI）可能会出现需要紧急医疗的症状。然而，鲜为人知的是，寻求医疗保健的时间周围的HIV-1血清转化在撒哈拉以南African.Methods：审查的临床，咨询，治疗和实验室记录以前的HIV-1血清阴性的高危成人，随后在每月或3个月的访问，谁血清转化，并参加了AHI队列。对所有HIV血清阴性血浆样本进行p24抗原（p24）检测，并对储存的转化前样本进行HIV-1 RNA（RNA）检测。与疟疾治疗，同时获得HIV-1的相关因素进行了评估，在多元logistic regression.Results：60名男性和12名女性（95%的75血清转换）进行了评价，包括43（60%）与p24阳性或RNA阳性或HIV-1不一致的快速抗体血清转换前。在诊断之前，54名患者（75%）报告发热，50名（69%）因症状性疾病寻求紧急护理，其中23名（32%）在非研究环境中寻求护理。29名患者（40%）接受了假定疟疾治疗。只有24%的发热患者接受了疟疾寄生虫检测。所有记录的涂片结果均为阴性。疟疾治疗与发热[校正比值比（aOR）：46，95%置信区间（CI）：3-725]和非研究环境（aOR：5，95% CI：3-64）密切相关。AHI被怀疑在六（12%）的患者谁提出紧急护理在research evaluation.Conclusions：大多数成人AHI寻求紧急医疗保健。这些人通常被假定为疟疾患者。提高认识的AHI在成人提出的护理可能提供机会，优化艾滋病毒预防战略。(C)2011年威科健康|利平科特威廉姆斯&威尔金斯
Background: Acute HIV-1 infection (AHI) may present with symptoms for which urgent healthcare is sought. However, little is known about healthcare seeking around the time of HIV-1 seroconversion in sub-Saharan Africa.Methods: Review of clinical, counselling, treatment and laboratory records of previously HIV-1 seronegative at-risk adults, followed at monthly or 3-monthly visits, who seroconverted and enrolled in an AHI cohort. All HIV-seronegative plasma samples were tested for p24 antigen (p24) and stored preseroconversion samples for HIV-1 RNA (RNA). Factors associated with malaria treatment while acquiring HIV-1 were evaluated in multiple logistic regression.Results: Sixty men and 12 women (95% of 75 seroconverters) were evaluated, including 43 (60%) with either p24-positive or RNA-positive or HIV-1 discordant rapid antibodies prior to seroconversion. Prior to diagnosis, 54 patients (75%) reported fever and 50 (69%) sought urgent care for symptomatic illness, including 23 (32%) who sought care in a nonresearch setting. Twenty-nine patients (40%) received presumptive malaria treatment. Only 24% of febrile patients were tested for malaria parasites. All documented smear results were negative. Malaria treatment was strongly associated with fever [ adjusted odds ratio (aOR): 46, 95% confidence interval (CI): 3-725] and nonresearch setting (aOR: 5, 95% CI: 3-64). AHI was suspected in six (12%) patients who presented for urgent care during research evaluation.Conclusions: The majority of adults with AHI seek urgent healthcare. These individuals are often presumptively treated for malaria. Improved recognition of AHI in adults presenting for care may offer opportunities for optimizing HIV prevention strategies. (C) 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins