Clinical features of acute human immunodeficiency virus infection in Taiwan: A multicenter study.

Te-Yu Lin, Chia-Jui Yang, Chung-Eng Liu, Hung-Jen Tang, Tun-Chieh Chen, Guan-Jhou Chen, Tung-Che Hung, Kuan-Yin Lin, Chien-Yu Cheng, Yi-Chien Lee, Shih-Ping Lin, Mao-Song Tsai, Yu-Lin Lee, Shu-Hsing Cheng, Chien-Ching Hung, Ning-Chi Wang

Journal: Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 2020;52(5):700-709

PMID: 29555411

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Abstract

BACKGROUND/PURPOSE

Acute HIV infection is characterized by a high concentration of HIV RNA in the plasma and rapid depletion of the CD4 cell count. This multicenter, retrospective observational study aimed to characterize the manifestations of acuteHIV infection in Taiwan.

METHODS

Between 1 January 2012 and 31 December 2016, all patients aged 20 years or greater who presented with acute HIV infection were included. Demographic and clinical characteristics of the patients at diagnosis were collected. Baseline laboratory assessment included hemogram, CD4 count, plasma HIV RNA load (PVL), serologic markers of syphilis and hepatitis A, B, and C viruses, and serum biochemistry.

RESULTS

The proportion of acute HIV infection was 6.9% among the patients with newly diagnosed HIV infection during the study period. The most common presenting symptoms of acute HIV infection were fever, fatigue, and myalgia. The median PVL at diagnosis was 5.9 log copies/ml, and median CD4 count was 307 cells/mm. A total of 68 patients (27%) had baseline CD4 count less than 200 cells/mm. Multiple logistic regression analysis, showed that the baseline CD4 count (OR, 4.02; p = 0.013) and aspartate aminotransaminase levels (OR, 3.49; p = 0.002) were associated with high PVL (>5 log copies/ml); and high baseline PVL (OR, 2.64; p = 0.002) was associated with symptomatic acute HIV infection.

CONCLUSIONS

Manifestations of acute HIV infection are nonspecific and of wide spectrum ranging from fever to severe illness. A higher proportion of patients with initial CD4 counts of 200 cells/mm or less during acute HIV infection warrants early, timely diagnosis and treatment to prevent rapid disease progression.

Address: Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.; Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.; Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan, ROC.; Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan, ROC.; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC.; Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health Welfare, Taoyuan, Taiwan, ROC.; Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan, ROC.; Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health Welfare, Taoyuan, Taiwan, ROC; School of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC.; Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan, ROC; Department of Internal Medicine, Catholic Fu-Jen Medical College, New Taipei City, Taiwan, ROC.; Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.; Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC; Department of Internal Medicine, Catholic Fu-Jen Medical College, New Taipei City, Taiwan, ROC.; Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health Welfare, Taoyuan, Taiwan, ROC; School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan, ROC.; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC; Department of Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan, ROC.; Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC. Electronic address: [email protected].

DOI: 10.1016/j.jmii.2018.01.005

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MeSH Terms: Adult, Anti-HIV Agents, CD4 Lymphocyte Count, Fatigue, Female, Fever, HIV Infections, Humans, Infectious Mononucleosis, Logistic Models, Male, Meningitis, Aseptic, Myalgia, RNA, Viral, Regression Analysis, Retrospective Studies, Syphilis, Taiwan, Viral Load, Young Adult