BACKGROUND: Symptoms of acute retroviral syndrome (ARS) may be used to identify patients with acute HIV-1 infection who seek care. ARS symptoms in African adults differ by region. We assessed whether reporting of ARS was associated with HIV-1 subtype in a multicentre African cohort study representing countries with predominant HIV-1 subtypes A, C and D. METHODOLOGY: ARS symptoms were assessed in adults enrolling ≤6 weeks after the estimated date of infection (EDI) in an acute and early HIV-1 infection cohort study. HIV-1 subtype was determined by POL-genotyping. We used log-binomial regression to compare ARS symptom prevalence among those with subtype A vs. C or D, adjusting for sex, time since enrollment, and enrolment viral load. RESULTS: Among 183 volunteers ascertained ≤6 weeks after EDI, 77 (42.0%) had subtype A, 83 (45.4%) subtype C, and 23 (12.6%) subtype D infection. Individuals with subtype A were 1.40 (95% CI: 1.17, 1.68) times as likely as individuals with subtypes C or D to report any ARS symptoms; each individual symptom other than rash was also more prevalent in subtype A than in subtype C or D, with prevalence ratios ranging from 1.94 (1.40, 2.70) for headache to 4.92 (2.24, 10.78) for lymphadenopathy. CONCLUSIONS: Individuals with subtype A were significantly more likely than individuals with subtypes C or D to report any ARS symptoms. HIV-1 subtypes may help explain differences in ARS that have been observed across regions in Africa, and may impact the yield of symptom-based screening strategies for acute HIV infection detection.
Sanders, E.J., Price, M.A., Karita, E., Kamali, A., Kilembe, W., Bekker, L.G., Lakhi, S., Inambao, M., Anzala, O., Fast, P.E., Gilmour, J., Powers, K.A.