Frequent detection of acute primary HIV infection in men in Malawi

Christopher D. Pilcher*, Matthew A. Price, Irving F. Hoffman, Shannon Galvin, Francis E A Martinson, Peter N. Kazembe, Joseph J. Eron, William C. Miller, Susan A. Fiscus, Myron S. Cohen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

111 Scopus citations


Background: Acute (antibody-negative) HIV infection is associated with high transmission potential but is rarely recognized. Design: Cross-sectional study. Methods: We examined the prevalence and predictors of acute HIV infection among 1361 consecutive male outpatients attending sexually transmitted disease (STD; n = 929) and dermatology (n = 432) clinics in Lilongwe, Malawi. Serum specimens negative for HIV antibodies were screened by HIV RNA PCR using a highly specific pooling/resolution testing algorithm. Results: Five-hundred and fifty-three men (40.6%) were HIV antibody positive and 24 (1.8%) had acute HIV infection; 23 of 24 acutely infected men were from the STD clinic, where they represented 4.5% of all HIV antibody-negative men and 5.0% of all HIV infections. HIV RNA levels for acutely infected men were significantly higher [median (interquartile range), 6.10 (5.19-6.54) log 10 HIV RNA copies/ml] than for 58 HIV antibody-positive men [4.42 (3.91-4.95) log10 copies/ml; P < 0.0001]. The factor most strongly associated with acute HIV infection was STD clinic attendance: (odds ratio, 15.2; 95% confidence interval, 2.04-113.0). In multivariate analysis considering only STD patients, factors associated with acute HIV infection included inguinal adenopathy, genital ulceration and age 24-26 years, the age stratum associated with peak incidence of HIV infection among Malawian men. Conclusions: Traditional HIV antibody tests alone are not sufficient to exclude HIV infection among men with acute STD in Malawi due to a surprising proportion of acute HIV infections in this population. Alternative screening methods are required for diagnosis of acute HIV infection; such screening could be important for research and for prevention of the sexual transmission of HIV in select populations.

Original languageEnglish (US)
Pages (from-to)517-524
Number of pages8
Issue number3
StatePublished - Feb 20 2004


  • Acute HIV infection
  • Diagnosis
  • Sexually transmitted disease
  • Voluntary counseling and testing

ASJC Scopus subject areas

  • Infectious Diseases
  • Immunology and Allergy
  • Immunology


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