Symptom Score May Predict HIV Infection in Community Screening Programs

In a cohort of adults participating in a community HIV screening program, a symptom-based questionnaire accurately predicted HIV infection, according to data published in Clinical Infectious Diseases.

Researchers from the University of California in San Diego sought to develop and validate the “San Diego Symptom Score” to test for HIV infection in individuals participating in the Early Test HIV screening program in San Diego. The symptom questionnaire assessed for 11 symptoms, including headache, pharyngitis, skin rash, myalgia, fever, fatigue, night sweats, gastrointestinal symptoms, arthralgia, weight loss, lymphadenopathy, and “other,” which participants were asked to specify.

Investigators randomly assigned 998 adults who either tested positive for HIV or who tested HIV nucleic acid test [NAT]-negative into a derivation or validation set. In the derivation set, symptoms significant for HIV infection in a multivariate logistic regression model were assigned a score value. Scores in the validation set were assessed using receiver operating characteristics and areas under the curve.

A total of 113 participants had an acute HIV infection, including 109 men who have sex with men. Participants with acute HIV infection reported a median of 4 symptoms compared with 0 symptoms in participants who tested negative for HIV (P <.01).

The results showed that fever, myalgia, and weight loss were significantly associated with acute HIV infection, corresponding to 11, 8, and 4 score points, respectively. The summed score yielded an area under the curve of 0.85 (95% CI, 0.78-0.92) and a score ≥11 was 72% sensitive and 92% specific with a diagnostic odds ratio of 70.27 (95% CI, 28.14-175.93).

“Once validated in populations with differing demographics, the [San Diego Symptom Score] may inform allocation of resources in settings that do not routinely utilize NAT to detect [acute HIV infection],” the investigators concluded.

Reference

Lin TC, Gianella S, Tenenbaum T, Little SJ, Hoenigl M. A simple symptom score for acute HIV infection in a San Diego community based screening program [published online December 25, 2017]. Clin Infect Dis. doi:10.1093/cid/cix1130