A study led by Denise Naniche, ISGlobal researcher, reports a rare case of rapid HIV progression during acute HIV infection, associated with an atypical seroconversion. The study was performed in the Centre for Health Research of Manhica (CISM), Mozambique, in collaboration with researchers from IrsiCaixa, Instituto Germans Trias i Pujol, the University of Western Australia, Perth, and the CISM.
Acute HIV infection is the period between virus infection and development of an immune response to the virus, detected by antiviral antibodies. The researchers searched to identify acute HIV infection among febrile patients visiting the centre by looking for viral RNA, instead of antibodies. One of the patients identified with acute HIV infection developed clinical symptoms of the disease and died within 14 weeks of the diagnosis. This is extremely rare, explains Dr. Naniche, because normally, after the acute infection, an immune response develops within 6 to 8 weeks during which antiviral antibodies are produced (seroconversion), and two to three years still pass before the progression of the disease warrants antiretroviral treatment according to the national guidelines. In contrast, the patient described here produced some atypical antibodies and died quickly. The authors think this is due to the fact that the patient was immuno-compromised: first, her immune system was genetically "handicapped" in that she could only recognize a limited amount of pathogens; second, she was co-infected with malaria, which likely enhanced HIV replication in T cells.
As Dr. Naniche points out "this type of extremely severe acute infection is likely to be very rare but we don't really know how many cases occur because with the standard HIV serology detection methods used in Sub Saharan Africa, these people wouldn't be identified as positive for the virus". What the authors do know, from a previous study on acute HIV infection, is that about 3% of the febrile adults that come to the Manhiça district hospital for malaria testing are actually in the acute HIV infection phase and do not know it. Given the high prevalence of malaria in the region, it is likely that some of them may contract malaria during the acute HIV phase. "In patients with a compromised or "handicapped" immune system, cases like the one described here could be more frequent than we think".
The study underlines the importance of establishing new generation rapid tests suitable for low resource countries in order to identify acute HIV infection and intervene early, particularly among immuno-compromised patients. According to UNAIDS, in Mozambique there are almost 2 million people living with HIV and almost 100,000 deaths in 2013 were due to AIDS.