HIV seroconversion illness different in injecting drug users

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Injecting drug users are less likely to present with fever and rash, the two most common symptoms associated with HIV seroconversion, according to a review of five cohort studies that recruit seroconverters.

The findings, published in the November 1 edition of the Journal of Acquired Immune Deficiency Syndromes, come from a review of cohorts in Geneva, Lyon, Montreal, Seattle and Sydney, and cover 378 patients diagnosed with an acute retroviral syndrome between 1985 and 2000. Symptoms were identified by standardised questionnaire.

Fever (50% vs 69%, p=0.04) and skin rash (21% vs 50%, p=0.002) were less frequent in those exposed to HIV through injecting drug use compared with those exposed through sexual intercourse. Genital ulceration was not reported amongst injecting drug users, but was seen in 4.6% of gay men and 14% of heterosexuals. Headache, pharyngitis and myalgia (muscle aches) were also less common in injecting drug users. No difference in symptoms was seen according to age or gender.

Glossary

p-value

The result of a statistical test which tells us whether the results of a study are likely to be due to chance and would not be confirmed if the study was repeated. All p-values are between 0 and 1; the most reliable studies have p-values very close to 0. A p-value of 0.001 means that there is a 1 in 1000 probability that the results are due to chance and do not reflect a real difference. A p-value of 0.05 means there is a 1 in 20 probability that the results are due to chance. When a p-value is 0.05 or below, the result is considered to be ‘statistically significant’. Confidence intervals give similar information to p-values but are easier to interpret. 

rash

A rash is an area of irritated or swollen skin, affecting its colour, appearance, or texture. It may be localised in one part of the body or affect all the skin. Rashes are usually caused by inflammation of the skin, which can have many causes, including an allergic reaction to a medicine.

syndrome

A group of symptoms and diseases that together are characteristic of a specific condition. AIDS is the characteristic syndrome of HIV.

 

seroconversion

The transition period from infection with HIV to the detectable presence of HIV antibodies in the blood. When seroconversion occurs (usually within a few weeks of infection), the result of an HIV antibody test changes from HIV negative to HIV positive. Seroconversion may be accompanied with flu-like symptoms.

 

myalgia

Muscle pain.

The authors suggested that the severity or recognition of symptoms in injecting drug users could be masked by the repeated use of opiates .

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References

Vanhems P et al. Clinical features of acute retroviral syndrome differ by route of infection but not by gender or age. JAIDS 31: 318-321, 2002.