Routine Screening May Be Better Option for Spotting HIV Early

Early HIV symptoms not specific enough to detect through clinical examination

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) HIV can be hard to diagnose early because symptoms can be basic and flu-like. New research identified signs of HIV infection that may help doctors decide which patients need to be tested.

A recent study review found that doctors often have a hard time confirming the presence or absence of HIV early (within six months of exposure) through a clinical exam alone. This makes it difficult to decide who should be tested.

The researchers concluded that the limited ability of a clinical exam to detect HIV infection early underlines the importance of routine screening and blood tests for HIV.

"If you're sexually active, get screened for HIV regularly."

The lead author of this study review was Evan Wood, MD, PhD, FRCPC, from the British Columbia Centre for Excellence in HIV/AIDS at St. Paul’s Hospital and the Department of Medicine at the University of British Columbia — both in Vancouver, British Columbia.

HIV (human immunodeficiency virus) is a virus that attacks the body's immune system, making it very hard to battle even the smallest illness. HIV is most often spread through sexual activity, but it can also spread from pregnant mother to child and through contact with contaminated blood.

This review included 16 studies published between 1980 and January 2014 and compared symptoms among patients with early HIV infection to those in HIV-negative patients.

The studies included 24,745 patients overall, 1,253 of whom had early HIV infection.

Past studies have shown that 50 to 90 percent of early HIV infection patients develop one or more of the following flu-like symptoms: fever, nausea/vomiting, weight loss, rashes, oral ulcers and swollen lymph nodes. However, the researchers explained that these symptoms are not specific enough to use for an early HIV diagnosis, and the absence of these symptoms does not necessarily rule out early HIV infection.

In this study, the researchers found that patients with genital ulcers were 5.4 times more likely to be diagnosed with early HIV than those who did not exhibit genital ulcers. Those who experienced weight loss were 4.7 times more likely to have early HIV compared to those who did not lose a lot of weight.

Vomiting and swollen lymph nodes each increased the likelihood of a patient having early HIV by 4.6 times, the researchers reported.

According to the findings, if a patient had a recent fever that disappeared at the time of the examination, the likelihood of HIV fell by 26 percent.

The findings also revealed that the patients who had swollen lymph nodes during their physical exams were 3.1 times more likely than those without swollen lymph nodes to be diagnosed with HIV. The absence of swollen lymph nodes was tied to a 30 percent lower risk of HIV.

The researchers concluded that adults should be routinely screened for HIV to increase early diagnoses and eliminate the confusion caused by the flu-like symptoms present in the early stages of infection.

"This study is not meant to be critical of physicians because of the limitations of our ability to discern who should and should not be tested for HIV infection," Dr. Wood said in a press release. "Rather, this study highlights the importance of routine HIV testing, just like we routinely test for other health conditions."

The researchers noted that recent data from a survey of 376 hospitals in the United States showed that less than 10 percent of hospitals had universal HIV screening for all inpatients and outpatients. In addition, less than 35 percent of hospitals said they screened some or all adult patients.

Dr. Wood and team said they believe a simple blood test taken during routine physical exams would significantly increase early detection of HIV.

Some study limitations arose due to the large variety of study populations — which included drug users, sex workers, men who have sex with men and emergency room patients — and the differences in HIV rates in different geographic locations. In addition, some of the studies were too old to include newer, more sensitive HIV testing techniques. Lastly, many of the studies were conducted in places where HIV is highly prevalent, such as sub-Saharan Africa.

This study was published July 15 in JAMA.

The Canada Research Chairs program provided funding.

Some of the study authors reported receiving funding from numerous pharmaceutical companies, including Pfizer Canada and Agouron Pharmaceuticals.

Review Date: 
July 15, 2014
Last Updated:
July 17, 2014