Frequency and Spectrum of Unexpected Clinical Manifestations of Primary HIV-1 Infection
Frequency and Spectrum of Unexpected Clinical Manifestations of Primary HIV-1 Infection
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DOI：
10.1093/cid/civ398
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发表时间：
2015-09-15
影响因子：
11.8
通讯作者：
Guenthard, Huldrych F.
中科院分区：
文献类型：
--
作者：
Braun, Dominique L.;Kouyos, Roger D.;Guenthard, Huldrych F.
背景关于原发性人类免疫缺陷病毒（HIV）感染（PHI）期间非预期临床表现的频率和谱的广泛和系统收集的数据尚未得到证实。我们在苏黎世原发性HIV感染研究中前瞻性地招募了290例有记录的PHI患者。典型急性逆转录病毒综合征（ARS）定义为发热加上至少1种通常认为与ARS相关的症状或体征;在无发热的情况下，存在2种或2种以上ARS症状或体征。非典型ARS定义为缺乏症状或体征，仅单一症状或体征且无发热，存在通常认为与ARS无关的症状或体征，或发生机会性疾病。根据估计的感染日期和首次HIV检测阳性计算诊断时间。我们分析了290例患者（271例男性）。202例（70%）患者表现为典型ARS，88例（30%）患者表现为非典型ARS。非典型ARS患者的住院率是典型ARS患者的4倍（43%比11%; P <0.001）。胃肠道是最常见的器官系统受累的患者不典型的表现。只有112例（38%）患者在首次就诊时怀疑感染HIV。与非典型ARS相比，典型ARS患者的诊断稍早，但差异无显著性（P = .3）。大部分PHI患者发生意外临床表现，并与大量发病率相关。在高危群体中，普遍的艾滋病毒检测可能是强制性的。
Background. Prospectively and systematically collected data on frequency and spectrum of unexpected clinical manifestations during primary human immunodeficiency virus (HIV) infection (PHI) have not been published.Methods. We prospectively enrolled 290 patients with documented PHI in the Zurich Primary HIV Infection Study. Typical acute retroviral syndrome (ARS) was defined as fever plus at least 1 symptom or sign typically considered to be associated with ARS; in absence of fever, presence of 2 or more ARS symptoms or signs. Atypical ARS was defined as lack of symptoms or signs, a single symptom or sign only and absence of fever, presence of symptoms or signs that are not considered typically associated with ARS, or occurrence of an opportunistic disease. Time to diagnosis was calculated based on estimated date of infection and first positive HIV test.Results. We analyzed 290 patients (271 males). PHI manifested with typical ARS in 202 (70%) and with atypical ARS in 88 (30%) patients. Patients with atypical ARS were hospitalized 4 times more often compared with typical ARS (43% vs 11%; P < .001). The gastrointestinal tract was the most frequent organ system affected in patients with atypical manifestations. Only in 112 (38%) patients was HIV infection suspected during the first medical attendance. Patients with typical ARS were diagnosed slightly earlier compared with atypical ARS, but this difference was not significant (P = .3).Conclusions. Unexpected clinical presentations occurred in a large fraction of patients with PHI and were associated with substantial morbidity. Universal HIV testing may be mandatory in high-risk groups.