Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Screening for Primary Human Immunodeficiency Virus Infection

Screening for Primary Human Immunodeficiency Virus Infection Weintrob et al1 recently pointed out the infrequency in diagnosis of primary human immunodeficiency virus (HIV) infection by performing HIV RNA polymerase chain reaction (PCR) in patients who present with viral syndrome and have risk factors for HIV infection. However, they do not address cost-effectiveness of this strategy and the use of empirical antiretroviral therapy. Fever, fatigue, myalgias, weight loss, headache, and nausea are nonspecific and common presenting symptoms in non–HIV-infected patients. The major risk factor for HIV transmission, an unprotected sexual intercourse, is also common. Because the cost of HIV RNA PCR testing is not insignificant,2 the authors should provide the total number of patients screened in the study. In addition, as they mentioned, initiation of antiretroviral therapy soon may reduce the long-lived, latently infected lymphocytes that act as a reservoir for HIV. I wonder if the authors initiate their screened patients on preemptive antiviral therapy until the test results become negative. Currently, the HIV RNA PCR test in many hospitals is a "send-out" test and takes several days to come back. Treatment history of the source patient is important to guide empirical antiretroviral selection because the regimens that are not part of the source patient's current treatment regimen may have a better chance of viral control.3 Lastly, in their algorithm, they should have recommended a follow-up HIV antibody testing in 3 to 6 months if the HIV RNA PCR test result is negative. At present, there are no controlled trials studying the sensitivity and specificity of viral RNA assays as diagnostic tests in adults with acute HIV-1 infection. References 1. Weintrob ACGiner JMenezes P et al. Infrequent diagnosis of primary human immunodeficiency virus infection: missed opportunities in acute care settings. Arch Intern Med. 2003;1632097- 2100PubMedGoogle ScholarCrossref 2. AuBuchon JPBirkmeyer JDBusch MP Cost-effectiveness of expanded human immunodeficiency virus-testing protocols for donated blood. Transfusion. 1997;3745- 51PubMedGoogle ScholarCrossref 3. Gerberding JL Occupational exposure to HIV in health care settings. N Engl J Med. 2003;348826- 833PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Screening for Primary Human Immunodeficiency Virus Infection

Tanvetyanon, Tawee
Archives of Internal Medicine , Volume 164 (6) – Mar 22, 2004
Download PDF
1 page

Screening for Primary Human Immunodeficiency Virus Infection

Abstract

Weintrob et al1 recently pointed out the infrequency in diagnosis of primary human immunodeficiency virus (HIV) infection by performing HIV RNA polymerase chain reaction (PCR) in patients who present with viral syndrome and have risk factors for HIV infection. However, they do not address cost-effectiveness of this strategy and the use of empirical antiretroviral therapy. Fever, fatigue, myalgias, weight loss, headache, and nausea are nonspecific and common presenting symptoms in...
Loading next page...
 
/lp/american-medical-association/screening-for-primary-human-immunodeficiency-virus-infection-UwtZEkZQoy

References (3)

Publisher
American Medical Association
Copyright
Copyright © 2004 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.164.6.680-a
Publisher site
See Article on Publisher Site

Abstract

Weintrob et al1 recently pointed out the infrequency in diagnosis of primary human immunodeficiency virus (HIV) infection by performing HIV RNA polymerase chain reaction (PCR) in patients who present with viral syndrome and have risk factors for HIV infection. However, they do not address cost-effectiveness of this strategy and the use of empirical antiretroviral therapy. Fever, fatigue, myalgias, weight loss, headache, and nausea are nonspecific and common presenting symptoms in non–HIV-infected patients. The major risk factor for HIV transmission, an unprotected sexual intercourse, is also common. Because the cost of HIV RNA PCR testing is not insignificant,2 the authors should provide the total number of patients screened in the study. In addition, as they mentioned, initiation of antiretroviral therapy soon may reduce the long-lived, latently infected lymphocytes that act as a reservoir for HIV. I wonder if the authors initiate their screened patients on preemptive antiviral therapy until the test results become negative. Currently, the HIV RNA PCR test in many hospitals is a "send-out" test and takes several days to come back. Treatment history of the source patient is important to guide empirical antiretroviral selection because the regimens that are not part of the source patient's current treatment regimen may have a better chance of viral control.3 Lastly, in their algorithm, they should have recommended a follow-up HIV antibody testing in 3 to 6 months if the HIV RNA PCR test result is negative. At present, there are no controlled trials studying the sensitivity and specificity of viral RNA assays as diagnostic tests in adults with acute HIV-1 infection. References 1. Weintrob ACGiner JMenezes P et al. Infrequent diagnosis of primary human immunodeficiency virus infection: missed opportunities in acute care settings. Arch Intern Med. 2003;1632097- 2100PubMedGoogle ScholarCrossref 2. AuBuchon JPBirkmeyer JDBusch MP Cost-effectiveness of expanded human immunodeficiency virus-testing protocols for donated blood. Transfusion. 1997;3745- 51PubMedGoogle ScholarCrossref 3. Gerberding JL Occupational exposure to HIV in health care settings. N Engl J Med. 2003;348826- 833PubMedGoogle ScholarCrossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Mar 22, 2004

Keywords: screening,hiv infection, primary

There are no references for this article.