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Published in: AIDS and Behavior 6/2009

01-12-2009 | Original Paper

Identifying People with Acute HIV Infection: Demographic Features, Risk Factors, and Use of Health Care among Individuals with AHI in North Carolina

Authors: Lisa B. Hightow-Weidman, Carol E. Golin, Kelly Green, Eva N. P. Shaw, Pia D. M. MacDonald, Peter A. Leone

Published in: AIDS and Behavior | Issue 6/2009

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Abstract

Identifying and counseling individuals with Acute HIV Infection (AHI) offers a critical opportunity to avert preventable HIV transmission, however, opportunities to recognize these individuals may be missed. We surveyed 32 adults diagnosed with AHI during voluntary HIV testing from 1/1/03 to 2/28/05 in publicly funded testing sites in NC to describe their clinical, social, and behavioral characteristics. Eighty-one percent of participants were men; 59% were African American. Seventy-five percent experienced symptoms consistent with acute retroviral syndrome; although 83% sought medical care for these symptoms, only 15% were appropriately diagnosed at that initial medical visit, suggesting opportunities to diagnose these individuals earlier were missed. Eighty-five percent of the men engaged in sex with men. More than 50% of the participants thought they were infected with HIV by a steady partner. This study yields important information to assist in identifying populations at risk for or infected with AHI and designing both primary and secondary prevention interventions.
Literature
go back to reference Bollinger, R. C., Brookmeyer, R. S., Mehendale, S. M., Paranjape, R. S., Shepherd, M. E., Gadkari, D. A., et al. (1997). Risk factors and clinical presentation of acute primary HIV infection in India. Journal of the American Medical Association, 278, 2085–2089. doi:10.1001/jama.278.23.2085.CrossRefPubMed Bollinger, R. C., Brookmeyer, R. S., Mehendale, S. M., Paranjape, R. S., Shepherd, M. E., Gadkari, D. A., et al. (1997). Risk factors and clinical presentation of acute primary HIV infection in India. Journal of the American Medical Association, 278, 2085–2089. doi:10.​1001/​jama.​278.​23.​2085.CrossRefPubMed
go back to reference CDC. (2003). HIV/STD risks in young men who have sex with men who do not disclose their sexual orientation: Six US Cities, 1994–2000. Atlanta: Centers for Disease Control and Prevention, 2003. CDC. (2003). HIV/STD risks in young men who have sex with men who do not disclose their sexual orientation: Six US Cities, 1994–2000. Atlanta: Centers for Disease Control and Prevention, 2003.
go back to reference CDC. (2007). Cases of HIV infection and AIDS in the United States and dependent areas, 2005. HIV/AIDS Surveillance Report, 17. CDC. (2007). Cases of HIV infection and AIDS in the United States and dependent areas, 2005. HIV/AIDS Surveillance Report, 17.
go back to reference Celum, C. L., Buchbinder, S. P., Donnell, D., Douglas, J. M., Jr, Mayer, K., Koblin, B., et al. (2001). Early human immunodeficiency virus (HIV) infection in the HIV network for prevention trials vaccine preparedness Cohort: Risk behaviors, symptoms, and early plasma and genital tract virus load. The Journal of Infectious Diseases, 183, 23–35. doi:10.1086/317658.CrossRefPubMed Celum, C. L., Buchbinder, S. P., Donnell, D., Douglas, J. M., Jr, Mayer, K., Koblin, B., et al. (2001). Early human immunodeficiency virus (HIV) infection in the HIV network for prevention trials vaccine preparedness Cohort: Risk behaviors, symptoms, and early plasma and genital tract virus load. The Journal of Infectious Diseases, 183, 23–35. doi:10.​1086/​317658.CrossRefPubMed
go back to reference Colfax, G. N., Buchbinder, S. P., Cornelisse, P. G. A., Vittinghoff, E., Mayer, K., & Celum, C. (2002). Sexual risk behaviors and implications for secondary HIV transmission during and after HIV seroconversion. AIDS (London, England), 16, 1529–1535. doi:10.1097/00002030-200207260-00010. Colfax, G. N., Buchbinder, S. P., Cornelisse, P. G. A., Vittinghoff, E., Mayer, K., & Celum, C. (2002). Sexual risk behaviors and implications for secondary HIV transmission during and after HIV seroconversion. AIDS (London, England), 16, 1529–1535. doi:10.​1097/​00002030-200207260-00010.
go back to reference Daar, E. S., Little, S., Pitt, J., Santangelo, J., Ho, P., Harawa, N., et al. (2001). Diagnosis of primary HIV-1 Infection. Annals of Internal Medicine, 134, 25–29.PubMed Daar, E. S., Little, S., Pitt, J., Santangelo, J., Ho, P., Harawa, N., et al. (2001). Diagnosis of primary HIV-1 Infection. Annals of Internal Medicine, 134, 25–29.PubMed
go back to reference CDC. (2004). HIV transmission among black college student and non-student men who have sex with men–North Carolina, 2003. Morbidity and Mortality Weekly Report, 53, 731–734. CDC. (2004). HIV transmission among black college student and non-student men who have sex with men–North Carolina, 2003. Morbidity and Mortality Weekly Report, 53, 731–734.
go back to reference Doll, L. S., Petersen, L. R., White, C. R., Johnson, E. S., & Ward, J. S. (1992). Homosexually and nonhomosexually identified men who have sex with men: A behavioral comparison. Journal of Sex Research, 29, 1–14.CrossRef Doll, L. S., Petersen, L. R., White, C. R., Johnson, E. S., & Ward, J. S. (1992). Homosexually and nonhomosexually identified men who have sex with men: A behavioral comparison. Journal of Sex Research, 29, 1–14.CrossRef
go back to reference Fiebig, E. W., Wright, D. J., Rawal, B. D., Garrett, P. E., Schumacher, R. T., Peddada, L., et al. (2003). Dynamics of HIV viremia and antibody seroconversion in plasma donors: Implications for diagnosis and staging of primary HIV infection. AIDS (London, England), 17, 1871–1879. doi:10.1097/00002030-200309050-00005. Fiebig, E. W., Wright, D. J., Rawal, B. D., Garrett, P. E., Schumacher, R. T., Peddada, L., et al. (2003). Dynamics of HIV viremia and antibody seroconversion in plasma donors: Implications for diagnosis and staging of primary HIV infection. AIDS (London, England), 17, 1871–1879. doi:10.​1097/​00002030-200309050-00005.
go back to reference Goldbaum, G., Perdue, T., Wolitski, R., Rietmeijer, C., Hedrich, A., Wood, R., et al. (1998). Differences in risk behavior and sources of AIDS information among gay, bisexual, and straight-identified men who have sex with men. AIDS and Behavior, 2, 13–21. doi:10.1023/A:1022399021926.CrossRef Goldbaum, G., Perdue, T., Wolitski, R., Rietmeijer, C., Hedrich, A., Wood, R., et al. (1998). Differences in risk behavior and sources of AIDS information among gay, bisexual, and straight-identified men who have sex with men. AIDS and Behavior, 2, 13–21. doi:10.​1023/​A:​1022399021926.CrossRef
go back to reference Hecht, F. M., Busch, M. P., Rawal, B. D., Webb, M., Rosenberg, E., Swanson, M., et al. (2002). Use of laboratory tests and clinical symptoms for identification of primary HIV infection. AIDS (London, England), 16, 1119–1129. doi:10.1097/00002030-200205240-00005. Hecht, F. M., Busch, M. P., Rawal, B. D., Webb, M., Rosenberg, E., Swanson, M., et al. (2002). Use of laboratory tests and clinical symptoms for identification of primary HIV infection. AIDS (London, England), 16, 1119–1129. doi:10.​1097/​00002030-200205240-00005.
go back to reference Jacquez, J. A., Koopman, J. S., Simon, C. P., & Longini, L. M. (1994). Role of the primary infection in epidemics of HIV infection in gay Cohorts. Journal of Acquired Immune Deficiency Syndromes, 7, 1169–1184.PubMed Jacquez, J. A., Koopman, J. S., Simon, C. P., & Longini, L. M. (1994). Role of the primary infection in epidemics of HIV infection in gay Cohorts. Journal of Acquired Immune Deficiency Syndromes, 7, 1169–1184.PubMed
go back to reference Kennamer, J. D., Honnold, J., Bradford, J., & Hendricks, M. (2000). Differences in disclosure of sexuality among African American and white gay/bisexual men: Implications for HIV/AIDS prevention. AIDS Education and Prevention, 12, 519–531.PubMed Kennamer, J. D., Honnold, J., Bradford, J., & Hendricks, M. (2000). Differences in disclosure of sexuality among African American and white gay/bisexual men: Implications for HIV/AIDS prevention. AIDS Education and Prevention, 12, 519–531.PubMed
go back to reference Kingsley, L., Kaslow, R., Rinaldo, C., Detre, K., Odaka, N., Vanraden, M., et al. (1987). Risk factors for seroconversion to human immunodeficiency virus among male homosexuals: Results from the multicenter AIDS Cohort study. Lancet, 329, 345–349. doi:10.1016/S0140-6736(87)91725-9.CrossRef Kingsley, L., Kaslow, R., Rinaldo, C., Detre, K., Odaka, N., Vanraden, M., et al. (1987). Risk factors for seroconversion to human immunodeficiency virus among male homosexuals: Results from the multicenter AIDS Cohort study. Lancet, 329, 345–349. doi:10.​1016/​S0140-6736(87)91725-9.CrossRef
go back to reference Koopman, J. S., Jacquez, J. A., Welch, G. W., Simon, C. P., Foxman, B., Pollock, S. M., et al. (1997). The role of early HIV infection in the spread of HIV through populations. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 14, 249–258.PubMed Koopman, J. S., Jacquez, J. A., Welch, G. W., Simon, C. P., Foxman, B., Pollock, S. M., et al. (1997). The role of early HIV infection in the spread of HIV through populations. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 14, 249–258.PubMed
go back to reference Leynaert, B., Downs, A. M., & de Vincenzi, I. (1998). Heterosexual transmission of human immunodeficiency virus: Variability of infectivity throughout the course of infection. American Journal of Epidemiology, 148, 88–96.PubMed Leynaert, B., Downs, A. M., & de Vincenzi, I. (1998). Heterosexual transmission of human immunodeficiency virus: Variability of infectivity throughout the course of infection. American Journal of Epidemiology, 148, 88–96.PubMed
go back to reference Lindback, S., Thorstensson, R., Karlsson, A. C., Sydow, M., Flamholc, L., Blaxhult, A., et al. (2000). Diagnosis of primary HIV-1 infection and duration of follow-up after HIV exposure. AIDS (London, England), 14, 2333–2339. doi:10.1097/00002030-200010200-00014. Lindback, S., Thorstensson, R., Karlsson, A. C., Sydow, M., Flamholc, L., Blaxhult, A., et al. (2000). Diagnosis of primary HIV-1 infection and duration of follow-up after HIV exposure. AIDS (London, England), 14, 2333–2339. doi:10.​1097/​00002030-200010200-00014.
go back to reference Millett, G., Malebranche, D., Mason, B., & Spikes, P. (2005). Focusing “down low”: Bisexual black men, heterosexual black women, and HIV risk. Journal of the National Medical Association, 97, 52S–59S.PubMed Millett, G., Malebranche, D., Mason, B., & Spikes, P. (2005). Focusing “down low”: Bisexual black men, heterosexual black women, and HIV risk. Journal of the National Medical Association, 97, 52S–59S.PubMed
go back to reference Pao, D., Fisher, M., Hue, S., Dean, G., Murphy, G., Cane, P. A., et al. (2005). Transmission of HIV-1 during primary infection: Relationship to sexual risk and sexually transmitted infections. AIDS (London, England), 19, 85–90. doi:10.1097/00002030-200501030-00010. Pao, D., Fisher, M., Hue, S., Dean, G., Murphy, G., Cane, P. A., et al. (2005). Transmission of HIV-1 during primary infection: Relationship to sexual risk and sexually transmitted infections. AIDS (London, England), 19, 85–90. doi:10.​1097/​00002030-200501030-00010.
go back to reference Pilcher, C. D., Eron, J. J., Vemazza, P. L., Battegay, M., Harr, T., Yerly, S., et al. (2001a). Sexual transmission during the incubation period of primary HIV infection. Journal of the American Medical Association, 286, 1713–1714. doi:10.1001/jama.286.14.1713.CrossRefPubMed Pilcher, C. D., Eron, J. J., Vemazza, P. L., Battegay, M., Harr, T., Yerly, S., et al. (2001a). Sexual transmission during the incubation period of primary HIV infection. Journal of the American Medical Association, 286, 1713–1714. doi:10.​1001/​jama.​286.​14.​1713.CrossRefPubMed
go back to reference Pilcher, C. D., Fiscus, S. A., Nguyen, T. Q., Foust, E., Wolf, L., Williams, D., et al. (2005). Detection of acute infections during HIV testing in North Carolina. The New England Journal of Medicine, 352, 1873–1883. doi:10.1056/NEJMoa042291.CrossRefPubMed Pilcher, C. D., Fiscus, S. A., Nguyen, T. Q., Foust, E., Wolf, L., Williams, D., et al. (2005). Detection of acute infections during HIV testing in North Carolina. The New England Journal of Medicine, 352, 1873–1883. doi:10.​1056/​NEJMoa042291.CrossRefPubMed
go back to reference Pilcher, C. D., Shugars, D. C., Fiscus, S. A., Miller, W. C., Menezes, P., Giner, J., et al. (2001b). HIV in body fluids during primary HIV infection: Implications for pathogenesis, treatment and public health. AIDS (London, England), 15, 837–845. doi:10.1097/00002030-200105040-00004. Pilcher, C. D., Shugars, D. C., Fiscus, S. A., Miller, W. C., Menezes, P., Giner, J., et al. (2001b). HIV in body fluids during primary HIV infection: Implications for pathogenesis, treatment and public health. AIDS (London, England), 15, 837–845. doi:10.​1097/​00002030-200105040-00004.
go back to reference Pilcher, C. D., Tien, C. H., Eron, J. J., Vernazza, P. L., Leu, S. Y., Stewer, P. W., et al. (2004). Brief but efficient: Acute HIV infection and the sexual transmission of HIV. The Journal of Infectious Diseases, 189, 1785–1792. doi:10.1086/386333.CrossRefPubMed Pilcher, C. D., Tien, C. H., Eron, J. J., Vernazza, P. L., Leu, S. Y., Stewer, P. W., et al. (2004). Brief but efficient: Acute HIV infection and the sexual transmission of HIV. The Journal of Infectious Diseases, 189, 1785–1792. doi:10.​1086/​386333.CrossRefPubMed
go back to reference Pincus, J. M., Crosby, S. S., Losina, E., King, E. R., LaBelle, C., & Freedberg, K. A. (2003). Acute human immunodeficiency virus infection in patients presenting to an Urban Urgent Care Center. Clinical Infectious Diseases, 37, 1699–1704. doi:10.1086/379772.CrossRefPubMed Pincus, J. M., Crosby, S. S., Losina, E., King, E. R., LaBelle, C., & Freedberg, K. A. (2003). Acute human immunodeficiency virus infection in patients presenting to an Urban Urgent Care Center. Clinical Infectious Diseases, 37, 1699–1704. doi:10.​1086/​379772.CrossRefPubMed
go back to reference Ross, M. W., Essien, E. J., Williams, M. L., & Fernandez-Esquer, M. E. (2003). Concordance between sexual behavior and sexual identity in street outreach samples of four racial/ethnic groups. Sexually Transmitted Diseases, 30, 110–113. doi:10.1097/00007435-200302000-00003.CrossRefPubMed Ross, M. W., Essien, E. J., Williams, M. L., & Fernandez-Esquer, M. E. (2003). Concordance between sexual behavior and sexual identity in street outreach samples of four racial/ethnic groups. Sexually Transmitted Diseases, 30, 110–113. doi:10.​1097/​00007435-200302000-00003.CrossRefPubMed
go back to reference Sabundayo, B. P., McArthur, J. H., Langan, S. J., Gallant, J. E., & Margolick, J. B. (2006). High frequency of highly active antiretroviral therapy modifications in patients with acute or early human immunodeficiency virus infection. Pharmacotherapy, 26, 674–681. doi:10.1592/phco.26.5.674.CrossRefPubMed Sabundayo, B. P., McArthur, J. H., Langan, S. J., Gallant, J. E., & Margolick, J. B. (2006). High frequency of highly active antiretroviral therapy modifications in patients with acute or early human immunodeficiency virus infection. Pharmacotherapy, 26, 674–681. doi:10.​1592/​phco.​26.​5.​674.CrossRefPubMed
go back to reference Schacker, T., Collier, A. C., Hughes, J., Shea, T., & Corey, L. (1996). Clinical and epidemiologic features of primary HIV infection. Annals of Internal Medicine, 125, 257–264.PubMed Schacker, T., Collier, A. C., Hughes, J., Shea, T., & Corey, L. (1996). Clinical and epidemiologic features of primary HIV infection. Annals of Internal Medicine, 125, 257–264.PubMed
go back to reference Schacker, T. W., Hughes, J. P., Shea, T., Coombs, R. W., & Corey, L. (1998). Biological and virologic characteristics of primary HIV infection. Annals of Internal Medicine, 128, 613–620.PubMed Schacker, T. W., Hughes, J. P., Shea, T., Coombs, R. W., & Corey, L. (1998). Biological and virologic characteristics of primary HIV infection. Annals of Internal Medicine, 128, 613–620.PubMed
go back to reference Schwarcz, S. K., Kellogg, T. A., Kohn, R. P., Katz, M. H., Lemp, G. F., & Bolan, G. A. (1995). Temporal trends in human immunodeficiency virus seroprevalence and sexual behavior at the San Francisco Municipal sexually transmitted disease Clinic, 1989–1992. American Journal of Epidemiology, 142, 314–322.PubMed Schwarcz, S. K., Kellogg, T. A., Kohn, R. P., Katz, M. H., Lemp, G. F., & Bolan, G. A. (1995). Temporal trends in human immunodeficiency virus seroprevalence and sexual behavior at the San Francisco Municipal sexually transmitted disease Clinic, 1989–1992. American Journal of Epidemiology, 142, 314–322.PubMed
go back to reference Siegel, K., Karus, D., & Raveis, V. H. (1997). Testing and treatment behaviour of HIV-infected women: White, African-American, Puerto Rican comparisons. AIDS Care, 9, 297–309.PubMedCrossRef Siegel, K., Karus, D., & Raveis, V. H. (1997). Testing and treatment behaviour of HIV-infected women: White, African-American, Puerto Rican comparisons. AIDS Care, 9, 297–309.PubMedCrossRef
go back to reference Vanhems, P., Allard, R., Cooper, D. A., Perrin, L., Vizzard, J., Hirschel, B., et al. (1997). Acute human immunodeficiency virus type 1 disease as a mononucleosis-like illness: Is the diagnosis too restrictive? Clinical Infectious Diseases, 24, 965–970.PubMed Vanhems, P., Allard, R., Cooper, D. A., Perrin, L., Vizzard, J., Hirschel, B., et al. (1997). Acute human immunodeficiency virus type 1 disease as a mononucleosis-like illness: Is the diagnosis too restrictive? Clinical Infectious Diseases, 24, 965–970.PubMed
go back to reference Wawer, M. J., Gray, R. H., Sewankambo, N. K., Serwadda, D., Li, X., Laeyendecker, O., et al. (2005). Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda. The Journal of Infectious Diseases, 191, 1403–1409. doi:10.1086/429411.CrossRefPubMed Wawer, M. J., Gray, R. H., Sewankambo, N. K., Serwadda, D., Li, X., Laeyendecker, O., et al. (2005). Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda. The Journal of Infectious Diseases, 191, 1403–1409. doi:10.​1086/​429411.CrossRefPubMed
go back to reference Wohl, A. R., Johnson, D. F., Lu, S., Jordan, W., Beall, G., Currier, J., et al. (2002). HIV risk behaviors among African American men in Los Angeles county who self-identify as heterosexual. Journal of Acquired Immune Deficiency Syndromes, 31, 354–360.PubMed Wohl, A. R., Johnson, D. F., Lu, S., Jordan, W., Beall, G., Currier, J., et al. (2002). HIV risk behaviors among African American men in Los Angeles county who self-identify as heterosexual. Journal of Acquired Immune Deficiency Syndromes, 31, 354–360.PubMed
go back to reference Yerly, S., Vora, S., Rizzardi, P., Chave, J. P., Vernazza, P. L., Flepp, M., et al. (2001). Acute HIV infection: Impact on the spread of HIV and transmission of drug resistance. AIDS (London, England), 15, 2287–2292. doi:10.1097/00002030-200111230-00010. Yerly, S., Vora, S., Rizzardi, P., Chave, J. P., Vernazza, P. L., Flepp, M., et al. (2001). Acute HIV infection: Impact on the spread of HIV and transmission of drug resistance. AIDS (London, England), 15, 2287–2292. doi:10.​1097/​00002030-200111230-00010.
Metadata
Title
Identifying People with Acute HIV Infection: Demographic Features, Risk Factors, and Use of Health Care among Individuals with AHI in North Carolina
Authors
Lisa B. Hightow-Weidman
Carol E. Golin
Kelly Green
Eva N. P. Shaw
Pia D. M. MacDonald
Peter A. Leone
Publication date
01-12-2009
Publisher
Springer US
Published in
AIDS and Behavior / Issue 6/2009
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-008-9519-5

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