Primary HIV Infection in Patients Presenting with Conventional Sexually Transmitted Infections (STIs) in Ethiopia: Magnitude and Risk Factors
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Date
2006-07
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Addis Abeba Universty
Abstract
Inclusion of incidence data in the surveillance system of HIV is important in order
to generate accurate data for effective prevention and control of the pandemic.
Retrospective cross-sectional HIV seroprevalence and seroincidence survey was
conducted to determine the magnitude of Primary HIV Infection (PHI) and, to
identify and describe factors associated with it on stored sera of 455 STIs cases
that had been collected and stored during the validation study of syndromic case
management algorithms for STIs in Ethiopia, between January - May 2003.
Standard HIV-antibody tests were done on all sera and IgG-capture BED-EIA on
positive samples for detecting recent infections. Negative Serum samples for HIV
antibodies were screened by nucleic acid amplification (HIV RNA PCR) for viral
RNA. Incidence was calculated using the consensus formula. OR with 95% CI
was used to measure the degree of association between associated factors and
PHI and, logistic regression analysis was done to identify predictors of PHI.
The overall HIV1/2 seropositivity was found to be 33% and the rate varies among
the major STI syndromes, namely, VDS(35%), UDS(20.2%) and GUS(60.5%).
Out of the 150 HIV antibody positive cases 15 (prevalence, 3.3%) were recently
infected and, annual HIV incidence was estimated to be 11.8% (95% CI, 6.02,
17.58). Acute HIV infection was detected in 7 cases (prevalence, 1.5%) out of
305 HIV antibody negative sera indicating that standard HIV-antibody tests
detected only 95.5% of the total HIV infections. The over all prevalence of PHI
was 4.8%. Considering both recent and acute infections annual HIV incidence
was estimated to be10.1% (95% CI, 5.13 - 14.97).
Diagnosis of syphilis was found to be an independent risk factor for PHI for both
sexes. Age group 35 – 39 years in males was found to be significantly associated
with PHI.
The estimated high incidence (10.1%) of HIV-1 infection in this study population
indicated that HIV infection is still spreading and targeted intervention is highly
recommended. Strong and sustained Provider Initiated HIV Counseling and
Testing (PIHCT) with subsequent follow up is recommended for STI patients,
particularly those with GUS, during their first appearance at health institutions.
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Keywords
Primary HIV Infection in Patients Presenting