Missed opportunities for diagnosing primary HIV infection
- 1Department of HIV/GU Medicine, Brighton and Sussex University Hospitals, Brighton, UK
- 2Virus Reference Department, Centre for Infections, Health Protection Agency
- Dr Darshan Sudarshi, Department of HIV/GU Medicine, Lawson Unit, Eastern Road, Brighton, BN2 5BE, UK;
- Accepted 22 October 2007
- Published Online First 30 October 2007
Objective: To investigate the extent to which primary HIV infection (PHI) presents to healthcare providers and the degree to which it is unrecognised.
Methods: All individuals diagnosed with having recent HIV infection between 2003 and 2005 were identified (based on the following criteria: an evolving antibody response, negative HIV test within 18 months or a serological testing algorithm for recent HIV seroconversion). Symptoms of PHI and previous presentation to other healthcare providers were ascertained from HIV clinic notes and laboratory records (a single laboratory performing all of the HIV tests in the area).
Results: Of the 108 subjects, 103 (95%) were male and 93 (86%) were men who had sex with men. A total of 76 of the 108 individuals (70%) reported symptoms of seroconversion. Of these, 40 (53%) presented to a healthcare provider during the symptomatic period. Of these, 21 (52%) were diagnosed with having PHI at first presentation. In the 19 patients (48%) in which a diagnosis of having PHI was not made at first presentation, 15 were seen in primary care, 3 in accident and emergency, and 1 in genitourinary medicine (GUM).
Conclusions: The diagnosis of PHI is often missed. Individuals in high-risk groups need to be informed to access healthcare when they experience symptoms of seroconversion. Non-HIV/GUM healthcare providers (especially primary care) may benefit from training in case recognition to improve rates of diagnosis.
MF devised the study. GD created the primary HIV infection (PHI) cohort used in the study. GM and JP were responsible for the laboratory testing for PHI. DS collected the data. DS and DP analysed the data, and DS and MF wrote the manuscript. All authors commented on the final manuscript. MF is the guarantor.
Competing interests: None.