Columbia Researcher Aims To Increase New Yorkers' Awareness Of Early Hiv Symptoms

Fever, headache, rash, muscle aches, sore throat, and swollen lymph glands—the early signs of HIV infection are similar to those of run-of-the-mill flu, and are therefore easily dismissed. But according to Robert Remien, PhD, a psychologist and researcher at Columbia’s HIV Center for Clinical Behavioral Studies, increasing awareness about the initial symptoms could help save lives and cut infection rates. According to the NYC Department of Health and Mental Hygiene, New York City remains the epicenter of the HIV/AIDS epidemic in the U.S. More than 100,000 New Yorkers are living with HIV, but many don’t know they’re infected. New York City has the highest AIDS case rate in the country, with more AIDS cases than Los Angeles, San Francisco, Miami, and Washington DC combined.

Remien, who is also an associate professor of clinical psychology, has been working with HIV-positive people in New York since the beginning of the epidemic in the early 1980s. The initial symptoms of HIV infection—which typically appear within a week or two after exposure to the virus—are experienced by about 50 to 70 percent of newly infected people.

In a study published in the journal AIDS and Behavior, Remien and his colleagues found that many people, including those in high-risk groups, did not know the symptoms of HIV infection or that they can appear around the time of infection. Research has shown that during this early period, people are highly infectious and can more easily transmit the virus then at any other time.

The lack of knowledge is alarming, he says, because it may be fueling the spread of the virus in New York and other cities with rising transmission rates. Some studies have suggested that as many as half of all new HIV infections were transmitted by people who had recently been infected and did not know they had HIV.

“The amount of virus in the body is extremely high in the first few months of the infection. People think they’re HIV-negative, but they’re actually the most infectious they could ever be,” said Remien, professor of clinical psychiatry. “If we can get people to start thinking that flu symptoms plus recent high-risk behavior may mean HIV, I think we could prevent a lot of additional infections.”

Remien is collaborating with the NYC and NYS Departments of Health on a research proposal that will develop and implement an intervention aimed at raising awareness among medical care providers, HIV-test counselors and high-risk groups to increase knowledge about the early symptoms of HIV infection and how to test for it in order to reduce transmission in communities of high HIV prevalence.

A big hurdle to greater awareness that the campaign must address is confusion over the types of HIV tests available, which prevents many people from learning their status even if they suspect they’ve been infected. HIV is most commonly diagnosed with a test that measures antibodies against the virus, but the test is unlikely to detect antibodies in the early period after infection. Few people know that a different “viral load” test can detect HIV very soon after exposure by directly measuring the amount of virus in the blood.

“People have been counseled that there is a three-month window between initial infection and detection, so they think there’s no sense in getting tested earlier,” Remien said. “But we need to promote the opposite. People should seek testing right away if they think they’ve been exposed, especially if they have symptoms following a short time after high-risk activity.”

Remien also advocates for better training for healthcare professionals. In a separate unpublished study, he found surprisingly low levels of awareness, especially about the appropriate testing procedures, among general practitioners and HIV counselors. Although current medical guidelines call for a viral load test if a potentially infected patient has symptoms but tests negative on a rapid antibody test, “that’s essentially not being done in clinical settings,” he added.

For the vast majority of people, just knowing they have the virus is enough to prompt changes in behavior that reduce further transmission, especially when they first find out.

“So many people with HIV in our studies wished they had known the meaning of their symptoms so they could have prevented passing the virus to others,” said Remien. “That really makes me think that more awareness can make a big impact in reducing the spread of HIV."