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JAMA. 2014 Jul 16;312(3):278-85. doi: 10.1001/jama.2014.5954.

Does this adult patient have early HIV infection?: The Rational Clinical Examination systematic review.

Author information

1
British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada2Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
2
Clinical Policy Office, Fraser Health Authority, Vancouver, British Columbia, Canada.
3
Department of Medicine, Oregon Health and Science University, Portland5Department of Public Health-Preventive Medicine, Oregon Health and Science University, Portland.
4
Durham Veterans Affairs Medical Center, Durham, North Carolina7Duke University Medical Center, Durham, North Carolina.

Abstract

IMPORTANCE:

Timely identification of human immunodeficiency virus (HIV) infection in adults can contribute to reduced mortality and likelihood of further HIV transmission. During the first 6 months after infection, known as early HIV infection, patients often report a well-described constellation of symptoms and signs. However, the literature examining utility of the clinical examination in identifying early infection has not been systematically assessed.

OBJECTIVE:

To assess the accuracy of symptoms and signs in identifying early HIV infection among adults.

DATA SOURCES:

We searched MEDLINE and EMBASE (1981-May, 2014) for articles investigating symptoms and signs of early HIV infection in adults and searched reference lists of retrieved articles.

STUDY SELECTION:

We retained original studies that compared symptoms and signs among patients with early HIV infection in comparison to HIV-negative individuals.

DATA EXTRACTION AND SYNTHESIS:

Data were extracted and used to calculate sensitivity, specificity, and likelihood ratios (LRs), and meta-analysis was used to calculate summary LRs.

RESULTS:

Of 1356 studies, 16 studies included data that were eligible for meta-analysis and included a total of 24,745 patients and 1253 cases of early HIV infection. Symptoms that increased the likelihood of early HIV infection the most included genital ulcers (LR, 5.4; 95% CI, 2.5-12), weight loss (LR, 4.7; 95% CI, 2.1-7.2), vomiting (LR, 4.6; 95% CI, 2.5-8.0), and swollen lymph nodes (LR, 4.6; 95% CI, 1.3-8.0). No symptoms had an LR that was 0.5 or lower, but the absence of recent fever (LR, 0.74; 95% CI, 0.64-0.84) slightly decreased the likelihood of early HIV infection. The presence of lymphadenopathy on physical examination was the most useful sign (LR, 3.1; 95% CI, 1.0-5.2). No sign had an LR of 0.5 or less, but the absence of lymphadenopathy slightly decreased the likelihood of early HIV infection (LR, 0.70, 95% CI, 0.49-0.92). Using data from studies that considered combinations of findings (range of possible findings, 4-17), the summary LR for individuals with 0 findings was 0.47 (95% CI, 0.38-0.58).

CONCLUSIONS AND RELEVANCE:

The limited utility of the clinical examination to detect or rule out early HIV infection highlights the importance of routine testing for HIV infection among adults.

PMID:
25027143
DOI:
10.1001/jama.2014.5954
[Indexed for MEDLINE]

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