Author:
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Pastor, Lucía; Casellas, Aina; Carrillo, Jorge; Alonso, Sergi; Parker, Erica; Fuente Soro, Laura; Jairoce, Chenjerai; Mandomando, Inácio; Blanco, Julià; Naniche, Denise
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Abstract:
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Acute HIV infection (AHI) is the period prior to seroconversion
characterized by high viral replication, hyper-transmission
potential and commonly, non-specific febrile illness. AHI
detection requires HIV-RNA viral load (VL) determination, which
has very limited access in low-income countries due to
restrictive costs and implementation constraints. We sought to
identify a biomarker that could enable AHI diagnosis in
scarce-resource settings, and to evaluate the feasibility of its
implementation. HIV-seronegative adults presenting at the
Manhica District Hospital, Mozambique, with reported-fever were
tested for VL. Plasma levels of 49 inflammatory biomarkers from
AHI (n = 61) and non-HIV infected outpatients (n = 65) were
determined by Luminex and ELISA. IP-10 demonstrated the best
predictive power for AHI detection (AUC = 0.88 [95%CI
0.80-0.96]). A cut-off value of IP-10 >/= 161.6 pg/mL
provided a sensitivity of 95.5% (95%CI 85.5-99.5) and a
specificity of 76.5% (95%CI 62.5-87.2). The implementation of an
IP-10 screening test could avert from 21 to 84 new infections
and save from US$176,609 to US$533,467 to the health system per
1,000 tested patients. We conclude that IP-10 is an accurate
biomarker to screen febrile HIV-seronegative individuals for
subsequent AHI diagnosis with VL. Such an algorithm is a
cost-effective strategy to prevent disease progression and a
substantial number of further HIV infections. |