Skip to main content
Journal cover image

Does this adult patient have early HIV infection?: The Rational Clinical Examination systematic review.

Publication ,  Journal Article
Wood, E; Kerr, T; Rowell, G; Montaner, JSG; Phillips, P; Korthuis, PT; Simel, DL
Published in: JAMA
July 16, 2014

IMPORTANCE: Timely identification of human immunodeficiency virus (HIV) infection in adults can contribute to reduced mortality and likelihood of further HIV transmission. During the first 6 months after infection, known as early HIV infection, patients often report a well-described constellation of symptoms and signs. However, the literature examining utility of the clinical examination in identifying early infection has not been systematically assessed. OBJECTIVE: To assess the accuracy of symptoms and signs in identifying early HIV infection among adults. DATA SOURCES: We searched MEDLINE and EMBASE (1981-May, 2014) for articles investigating symptoms and signs of early HIV infection in adults and searched reference lists of retrieved articles. STUDY SELECTION: We retained original studies that compared symptoms and signs among patients with early HIV infection in comparison to HIV-negative individuals. DATA EXTRACTION AND SYNTHESIS: Data were extracted and used to calculate sensitivity, specificity, and likelihood ratios (LRs), and meta-analysis was used to calculate summary LRs. RESULTS: Of 1356 studies, 16 studies included data that were eligible for meta-analysis and included a total of 24,745 patients and 1253 cases of early HIV infection. Symptoms that increased the likelihood of early HIV infection the most included genital ulcers (LR, 5.4; 95% CI, 2.5-12), weight loss (LR, 4.7; 95% CI, 2.1-7.2), vomiting (LR, 4.6; 95% CI, 2.5-8.0), and swollen lymph nodes (LR, 4.6; 95% CI, 1.3-8.0). No symptoms had an LR that was 0.5 or lower, but the absence of recent fever (LR, 0.74; 95% CI, 0.64-0.84) slightly decreased the likelihood of early HIV infection. The presence of lymphadenopathy on physical examination was the most useful sign (LR, 3.1; 95% CI, 1.0-5.2). No sign had an LR of 0.5 or less, but the absence of lymphadenopathy slightly decreased the likelihood of early HIV infection (LR, 0.70, 95% CI, 0.49-0.92). Using data from studies that considered combinations of findings (range of possible findings, 4-17), the summary LR for individuals with 0 findings was 0.47 (95% CI, 0.38-0.58). CONCLUSIONS AND RELEVANCE: The limited utility of the clinical examination to detect or rule out early HIV infection highlights the importance of routine testing for HIV infection among adults.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

July 16, 2014

Volume

312

Issue

3

Start / End Page

278 / 285

Location

United States

Related Subject Headings

  • Weight Loss
  • Vomiting
  • Ulcer
  • Physical Examination
  • Lymphatic Diseases
  • Humans
  • HIV Infections
  • General & Internal Medicine
  • Diagnosis, Differential
  • Adult
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Wood, E., Kerr, T., Rowell, G., Montaner, J. S. G., Phillips, P., Korthuis, P. T., & Simel, D. L. (2014). Does this adult patient have early HIV infection?: The Rational Clinical Examination systematic review. JAMA, 312(3), 278–285. https://doi.org/10.1001/jama.2014.5954
Wood, Evan, Thomas Kerr, Greg Rowell, Julio S. G. Montaner, Peter Phillips, P Todd Korthuis, and David L. Simel. “Does this adult patient have early HIV infection?: The Rational Clinical Examination systematic review.JAMA 312, no. 3 (July 16, 2014): 278–85. https://doi.org/10.1001/jama.2014.5954.
Wood E, Kerr T, Rowell G, Montaner JSG, Phillips P, Korthuis PT, et al. Does this adult patient have early HIV infection?: The Rational Clinical Examination systematic review. JAMA. 2014 Jul 16;312(3):278–85.
Wood, Evan, et al. “Does this adult patient have early HIV infection?: The Rational Clinical Examination systematic review.JAMA, vol. 312, no. 3, July 2014, pp. 278–85. Pubmed, doi:10.1001/jama.2014.5954.
Wood E, Kerr T, Rowell G, Montaner JSG, Phillips P, Korthuis PT, Simel DL. Does this adult patient have early HIV infection?: The Rational Clinical Examination systematic review. JAMA. 2014 Jul 16;312(3):278–285.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

July 16, 2014

Volume

312

Issue

3

Start / End Page

278 / 285

Location

United States

Related Subject Headings

  • Weight Loss
  • Vomiting
  • Ulcer
  • Physical Examination
  • Lymphatic Diseases
  • Humans
  • HIV Infections
  • General & Internal Medicine
  • Diagnosis, Differential
  • Adult