475. Differences in Clinical Manifestations of Acute and Early HIV-1 Infection between HIV-1 Subtypes in African Women
Session: Poster Abstract Session: HIV Primary Care
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • HIV posterlemonovich9.22.11.png (347.3 kB)
  • Background: Several HIV-1 subtypes exist in Africa. There are limited data on differences in clinical manifestations between women with various subtypes during acute (AI) and early (EI) HIV-1 infection.

    Methods: Data are from a longitudinal cohort of women from Uganda and Zimbabwe. Women who were initially HIV-negative were seen quarterly over 15-24 months, receiving a pelvic examination, HIV testing, and a behavioral interview at each visit. Fisher’s exact test and chi-square were used to compare clinical signs and symptoms among women with AI and EI versus HIV-negative controls. EI was defined as the first visit where a woman tested positive on an HIV enzyme immune assay, rapid test, and/or Western Blot. Women classified as HIV-negative serologically but found to be DNA PCR positive were considered as AI.

    Results: A total of 26 women were classified as AI, 192 as EI, with 654 HIV-negative controls.  Primary HIV infection (AI and EI) was associated with symptoms of unexplained fever (p<0.01), weight loss (p<0.01), and diarrhea (p=0.02); and signs of inguinal adenopathy (p<0.01), and cervical friability (p=0.01).  Among HIV-infected women, 39 had subtype A, 156 had subtype C, and 19 subtype D.  More women with HIV subtype D (26%) presented with unexplained fever versus women with subtype A (15%) or C (8%), p=0.03.  Women with subtype D were also more likely to have genital itching than women with other subtypes (p=0.03).  Women with subtype C were more likely to present with headaches (p=0.03) or inguinal adenopathy (p=0.02) than other women.  A higher viral load set point (log10 plasma viral load) was seen among women with weight loss (mean 4.68 vs. 4.19, p=0.03) and inguinal adenopathy (mean 4.52 vs. 4.14, p=0.01).  Among women reaching the primary endpoint of AIDS or the secondary endpoint of AIDS, death, or antiretroviral therapy initiation, there were no significant differences in clinical symptoms or signs during primary infection. 

    Conclusion: In African women with HIV-1 AI and EI, unexplained fever and genital itching are more common with subtype D and headache and inguinal adenopathy with subtype C. Initial clinical signs and symptoms were not associated with HIV-1 progression in this cohort of African women.


    Subject Category: H. HIV/AIDS and other retroviruses

    Tracy Lemonovich, MD1, Richard Watkins, MD, MS2,3, Charles Morrison, PhD4, Cynthia Kwok, MSPH4 and Robert Salata, MD5, (1)Case Western Reserve University, Cleveland, OH, (2)Division of Infectious Diseases, Akron General Medical Center, Akron, OH, (3)Northeast Ohio Medical University, Rootstown, OH, (4)Family Health International, Research Triangle Park, NC, (5)University Hospitals Case Medical Center, Cleveland, OH

    Disclosures:

    T. Lemonovich, None

    R. Watkins, None

    C. Morrison, None

    C. Kwok, None

    R. Salata, None

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