GPs missing signs of primary HIV infection in south London

Michael Carter
Estimated reading time 2 minutes
This article is more than 21 years old.

Symptoms of primary HIV infection, which include rash, fever, sore throat and swollen glands may not be connected to HIV infection by doctors in south London, an area of high HIV prevalence, according to a letter in the 8 March 2003 edition of the British Medical Journal.

Between May 1998 and April 1999 investigators retrospectively and anonymously tested 268 stored serum samples from patients aged 16 years or older who had presented at general practitioners with a maculopapular (patchy and bumpy) rash, sore throat, fever and swollen glands. Although these can be the symptoms of glandular fever, they can also be indicative of primary HIV infection. Samples had been submitted for testing by the virology laboratory at St Thomas's Hospital, which serves much of the inner south London area.

People with diagnosed HIV were excluded. Eight of the samples (3%) were positive for HIV antibodies and six gave results suggesting long-standing HIV infection. However, two tests were suggestive of primary HIV infection.

Glossary

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.

serum

Clear, non-cellular portion of the blood, containing antibodies and other proteins and chemicals.

 

primary infection

In HIV, usually defined as the first six months of infection.

exclusion criteria

Defines who cannot take part in a research study. Eligibility criteria may include disease type and stage, other medical conditions, previous treatment history, age, and gender. For example, many trials exclude women who are pregnant, to avoid any possible danger to a baby, or people who are taking a drug that might interact with the treatment being studied.

clinical trial

A research study involving participants, usually to find out how well a new drug or treatment works in people and how safe it is.

South London has a large African population amongst which late diagnosis of HIV, often in an in-patient setting is common. As reported on aidsmap Project Nasah, a large research project into the needs of Africans living with HIV in the UK, found that over 33% were diagnosed after being admitted for in-patient treatment of an illness that was subsequently identified as HIV-related.

The UK government’s National Strategy for Sexual Health and HIV has set targets for reducing the rate of late diagnosis.

The BMJ correspondents note that diagnosis of primary HIV infection provides an “opportunity to prevent the spread of HIV when patients are highly infectious” as well as offering prophylaxis against infections or treatment with HAART.

On the basis of their findings, they encourage more “risk assessment” and HIV testing of patients in south London.

Further information on this website

Fever and rash strongest signs of primary HIV infection - news story

Early short course HAART in primary HIV infection - Clinical trial information

Primary infection - Factsheet

References

Melzer M et al. HIV infection may also cause rash or glandular fever type illness British Medical Journal, 326: 552, 2003.

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