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There has been increasing interest in Papua New Guinea (PNG) in male circumcision (MC) for HIV (human immunodeficiency virus) prevention following compelling evidence from ecological studies and clinical trials in Africa, and the World Health Organization's recommendation in 2007 that MC be considered part of comprehensive HIV prevention programs in high-prevalence settings. Though no national policy has been established in PNG, East Sepik Province (ESP) commenced a formal program of MC in 2006, and there is evidence that PNG health workers are involved in other penile foreskin cutting activities in many areas. As part of a wider Male Circumcision Acceptability and Impact Study in PNG, we conducted an audit at a sample of PNG health facilities to assess their suitability for implementing a national MC program, and to identify issues that may arise in any future roll- out. The clinical audits demonstrated the difficulties with procurement and availability of equipment for general services around PNG, shortage of staff and capacity, and limitations of available clinical space. Results show that the ESP program has been successful; however, the success relies heavily on commitment from key workers to volunteer their time and services. A review of penile cutting activities by health care workers outside of the ESP program showed that the PNG health system is already involved in contemporary and traditional penile cutting practices via formal and informal arrangements: for example, by responding to complications from penile cuts performed by non-health workers, assisting community members to perform penile cutting through provision of equipment and advice, or providing regular penile foreskin cutting services for contemporary and traditional practices. [ABSTRACT FROM AUTHOR]

Summary. The critical events in clearance or persistence of hepatitis C virus (HCV) infection are unknown but likely to be determined early in acute infection. Type 1 and type 2 cytokine production was assessed by HCV peptide ELISpot and multiplex in vitro cytokine production assays in longitudinally collected samples from 20 untreated participants enrolled in the Australian Trial in Acute Hepatitis C (ATAHC); a prospective cohort of acute HCV infection (77% injecting drug users, IDU). Significantly higher interleukin-10 (IL-10) production ( P = 0.048), in the relative absence of interferon-gamma (IFN-γ) and IL-2 production, was present early in HCV infection in those who progressed to chronic infection. In contrast, viral clearance was associated with a greater magnitude and broader specificity of IFN-γ (magnitude P < 0.001, breadth P = 0.004) and IL-2 responses, in the relative absence of IL-10. Early IL-10 production was correlated with higher HCV RNA level at baseline ( P = 0.046) and week 12 ( P = 0.018), while IFN-γ and IL-2 production was inversely correlated with HCV RNA level at baseline (IFN-γ P = 0.020, IL-2 P = 0.050) and week 48 (IFN-γ P = 0.045, IL-2 P = 0.026). Intracellular staining (ICS) indicated the HCV-specific IFN-γ response was primarily from CD8+ T cells and NK cells, whereas IL-10 production was predominantly from monocytes, with a subset of IL-10 producing CD8+ T cells present only in those who progressed to chronic infection. IL-10, an immunoregulatory cytokine, appears to play a key role in progression to chronic HCV infection. [ABSTRACT FROM AUTHOR]

HCV transmission networks within the Australian Trial in Acute Hepatitis C occurred predominantly in HIV positive populations and almost exclusively in men who have sex with men. Both sexual and injecting drug use risk were observed within the same clusters.Background. Injecting drug users remain the population at greatest risk of acquiring hepatitis C virus (HCV) infection, although a recent increase in cases of sexually transmitted HCV infection has been observed among human immunodeficiency virus (HIV)–infected individuals. The extent to which these separate epidemics overlap is unknown.Methods. The Australian Trial in Acute Hepatitis C (ATAHC) enrolled 163 individuals (29% of whom were HIV infected) with recent HCV infection. E1/HVR1 sequences were used to construct phylogenetic trees demonstrating monophyletic clusters or pairs, and viral epidemic history and phylogeography were assessed using molecular clock analysis. Individual clusters were characterized by clinical and demographic characteristics.Results. Transmission through injection drug use occurred for 73% of subjects, with sexual transmission occurring for 18% (92% of whom were HIV infected). Among 112 individuals with available E1/HVR1 sequences, 23 (20%) were infected with a strain of HCV identical to that of another subject, comprising 4 homologous clusters and 3 monophyletic pairs, the majority of which (78%) were HIV infected. Clusters contained individuals with both injection drug use–related and sex-related acquisition, and in all clusters (except for 1 female HIV-uninfected pair), individuals identified as men who have sex with men, irrespective of HIV status.Conclusions. This large unique study of HIV-infected and HIV-uninfected individuals with recently acquired HCV infection demonstrates that clustering is common in the HIV-infected population and that it occurred almost invariably among men who have sex with men, irrespective of the actual mode of acquisition. These findings suggest the coexistence of both injection drug use and sexual risk behaviors for individuals in the same social networks and have implications for the development of public health messages.Clinical trial registration. NCT00192569. [ABSTRACT FROM AUTHOR]

Objectives The aim of the study was to explore the awareness of rectal microbicides, the use of pre-exposure prophylaxis (PREP) and the willingness to participate in biomedical HIV prevention trials in a cohort of HIV-negative gay men. Methods In a community-based cohort study, HIV-negative homosexually active men in Sydney, Australia were questioned about awareness of rectal microbicides, use of PREP, and willingness to participate in trials of such products. Predictors of awareness and willingness to participate were analysed by logistic regression. Use of PREP was examined prospectively. Results Overall, 14% had heard of rectal microbicides. Older ( P=0.05) and university-educated men ( P=0.001) were more likely to have knowledge of rectal microbicides. Almost one-quarter (24%) of men reported that they were likely/very likely to participate in rectal microbicide trials. Among those men with definite opinions on participation, awareness of rectal microbicides was significantly associated with unwillingness to participate [odds ratio (OR) 0.78, 95% confidence interval (CI) 0.65–0.93, P=0.007]. Willingness to participate in trials using antiretroviral drugs (ARVs) to prevent HIV infection was reported by 43% of men, and was higher among those who reported unprotected anal intercourse (UAI) with HIV-positive partners (OR 1.88, 95% CI 0.99–3.56). There was no evidence of current PREP use. Conclusions This study demonstrates that Australian gay men have had little experience with PREP use and rectal microbicides. About half would be willing to consider participation in trials using ARVs to prevent HIV infection. Extensive community education and consultation would be required before PREP or rectal microbicides could be trialled in populations of gay Australian men. [ABSTRACT FROM AUTHOR]

Issue Addressed: Health services are fundamental to reducing the burden of blood-borne and sexually transmitted infections (BBV/STI) in Indigenous communities. However, we know very little about young Indigenous people's use of mainstream and community-controlled health services for the prevention and treatment of these infections, or how health services can best support young people's efforts to prevent infection.Methods: University-researchers, a site co-ordinator and peer researchers developed a project and conducted interviews with 45 Aboriginal and Torres Strait Islander people aged between 17 and 26 years. Thematic analysis of interview notes identified key themes around health service use and experiences of Aboriginal Community-Controlled Health Services (ACCHS).Results: Most participants had accessed health services for the prevention or treatment of BBV/STI, with positive experiences characterised by the provision of information and feeling cared for. Participants described the comfort and understanding they experienced at ACCHS; personal relationships and having an Indigenous care provider present were important factors in the overwhelmingly positive accounts. Young people reported strategies for overcoming challenges to prevention and accessing treatment services, including being proactive by carrying condoms and persisting with behavioural intentions despite feeling shame.Conclusion: Our findings reinforce the important role both mainstream and community-controlled health services have in the prevention and treatment of blood-borne and sexually transmitted infections in young Indigenous people. We highlight opportunities to build on young people's strengths, such as their valuing of their health, their persistence, and their offers to support peers, to better prevent transmission of infections and enhance access to treatment. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify factors associated with current HIV (human immunodeficiency virus) testing practice at Port Moresby General Hospital and positive serostatus among children tested, as a basis for contributing to guidelines on HIV testing for children in Papua New Guinea. Data were extracted from hospital records to determine the demographic and presenting clinical characteristics of admitted children tested for HIV serostatus between 1 December 2005 and 30 November 2006. These data were compared with corresponding data from untested control children from the same wards. The same characteristics were compared between seropositive and seronegative cases. Odds ratios were derived for potential predictors of testing and its outcome. During the study period, HIV tests were reported on 215 children, of whom 57 were seropositive. Controls were 264 untested children. Tested children were more likely to be aged 18 months or less, to have been admitted for more than 7 days, and to have diarrhoea, be malnourished or have oral candidiasis. Among children tested, suspected tuberculosis as a presenting illness was significantly predictive of HIV-positive serostatus. This study indicates that certain clinical factors associated with HIV-positive status in children may not yet have been incorporated into testing practice, and underlines the importance of developing a systematic approach to testing children for HIV in Papua New Guinea. [ABSTRACT FROM AUTHOR]

Background. The Australian Trial in Acute Hepatitis C (ATAHC) is a National Institutes of Health--funded prospective cohort study of the natural history and efficacy of treatment in individuals with recently acquired hepatitis C. Enrollment is open to both human immunodeficiency virus (HIV)--infected and -uninfected individuals. The aim of this article was to evaluate characteristics and virological outcomes among HIV-infected individuals enrolled in ATAHC. Methods. Eligibility criteria included the first positive result of testing for anti-hepatitis C virus (HCV) antibody within 6 months and either clinical hepatitis diagnosed within the past 12 months or documented anti-HCV seroconversion within the past 24 months. Results. Of the initial 103 patients enrolled, 27 (26%) were HIV infected. HIV-infected patients were more likely to be older, to have HCV genotype 1 infection and high levels of HCV RNA at baseline than were HCV-monoinfected patients. Sexual acquisition accounted for the majority (56%) of HCV infections among HIV-infected patients, compared with only 8% of HCV-monoinfected patients. The median duration from estimated HCV infection to treatment was 30 weeks. Treatment with 24 weeks of pegylated interferon and ribavirin resulted in rates of undetectability of HCV RNA of 95%, 90%, and 80% at weeks 12, 24, and 48, respectively. Undetectability at week 4 was achieved in 44% of patients and yielded positive and negative predictive values for sustained virological response of 100% and 33%, respectively. Conclusions. Significant differences were demonstrated between HIV-infected and HIV-uninfected individuals enrolled in ATAHC. Treatment responses among HIV-infected individuals with both acute and early chronic infection are encouraging and support regular HCV screening of high-risk individuals and early treatment for recently acquired HCV infection. [ABSTRACT FROM AUTHOR]

Objective The aim of the study was to investigate the impact of treatment-related clearance of hepatitis C virus (HCV) on cognitive function. Methods A prospective study was conducted in 19 HCV-monoinfected and 15 HIV/HCV-coinfected individuals undergoing pegylated interferon α-2a and ribavirin therapy between April 2003 and August 2005. Neuropsychological, mood, and health-related quality of life (HRQOL) effects were assessed using computer-based battery, Trail Making Tests, Depression Anxiety Stress Scales and the Short Form-36 health survey. Results Pretreatment cognitive function, mood status, and HRQOL were similar between the HCV patient groups. Sustained virological response (SVR) rates were similar between HCV-monoinfected (68%) and HIV/HCV-coinfected (73%) groups. SVR was associated with significant improvements in some measures of cognitive function, independent of HRQOL improvement. Conclusions Our findings provide evidence to support cognitive effects of HCV independent of mood status and HRQOL profiles. [ABSTRACT FROM AUTHOR]

Objective We investigated the use of antiretroviral therapy regimens containing zidovudine or stavudine, using data from the TREAT Asia HIV Observational Database (TAHOD), a multicentre, prospective, observational study of an HIV-infected cohort in the Asia-Pacific Region. Methods A proportional hazards regression analysis of factors associated with the time to discontinuation of initial regimens containing zidovudine or stavudine and a logistic regression analysis to identify factors associated with a diagnosis of anaemia within 6 months of commencement of zidovudine in initial or subsequent regimens were performed. Results Patients who started zidovudine were more likely to stop within the first 9 months of treatment than those who started on stavudine; the reverse was true after 9 months. Anaemia (haemoglobin≤10 g/dL) occurred in the first 6 months in 57 of 433 patients (13%) on zidovudine. Baseline anaemia was the strongest predictive factor for subsequent anaemia, and prior antiretroviral therapy (ART) experience was protective for development of anaemia. Conclusions These data support baseline haemoglobin testing and avoidance of zidovudine if the patient is anaemic. The protective effect of prior ART for development of anaemia on zidovudine supports the short-term safety of a stavudine to zidovudine switch with routine haemoglobin monitoring in this cohort. Further studies in resource-poor settings of longer term efficacy and toxicities of ART switch strategies are needed. [ABSTRACT FROM AUTHOR]

Objective The aim of the study was to describe the use of nonoccupational postexposure prophylaxis (NPEP) in Australia, and to estimate the number of HIV infections that its use prevented. Methods We conducted a population-based observational cohort study of people who presented to antiretroviral prescribers in Eastern Australia, and reported a high-risk nonoccupational exposure to HIV, in 1998–2004. Prescribers collected data at baseline, 4 weeks and 6 months. Data collected included details of HIV exposure, drug regimens and HIV serostatus. Results The great majority of the 1601 participants were male (95%) and presented after male homosexual exposure (87%). Only 32% of exposures were to HIV-positive sources. Two antiretroviral drugs were prescribed after 48% of events, and three or more drugs after 52% of events. The median time to receipt of NPEP was 23 h. Side effects were reported by 66% of participants. No case of NPEP failure in an adherent individual was identified. It was estimated that 0.9–9.2 HIV infections had been prevented. This compared with a total of 1138 newly acquired HIV infections notified in the geographical area covered by the study. Conclusions In Australia, NPEP has been widely prescribed and is mainly targeted at high-risk exposures. Although there were no identified failures of NPEP, it is likely that only a small proportion of new HIV infections in the study area were prevented. NPEP may be a valuable preventive intervention for an individual, but it can only play a minor role in HIV prevention at the population level unless targeting can be further improved. [ABSTRACT FROM AUTHOR]

A retrospective cohort study was established of injecting drug users (IDUs) to assess evidence for hepatitis C virus (HCV) protective immunity through a comparison of incidence of initial HCV infection and HCV reinfection. Incidence of initial HCV infection was determined among HCV seronegative IDUs, and HCV reinfection determined among IDUs with newly acquired HCV infection, HCV viraemia and subsequent HCV RNA clearance. Serum was available for HCV RNA analysis from stored samples taken at the time of prior blood-borne virus screening. Potential HCV reinfection was defined as a positive HCV RNA following at least one negative HCV RNA. Incidence of initial HCV infection was 17/100 person-years (95% CI, 14–20/100 person-years). The incidence of potential HCV reinfection was 42/100 person-years (95% CI, 25–61/100 person-years), and after excluding cases without a change in HCV genotype and less than three consecutive HCV RNA negative assessment, incidence of reinfection was 31/100 person-years (95% CI, 17–62/100 person-years). Following adjustment for HCV risk behaviour variables the incidence rate ratio of HCV reinfection to initial infection was 1.11 ( P = 0.8). Several cases of HCV reinfection appear to have developed persistent infection. [ABSTRACT FROM AUTHOR]

Background: Early detection and treatment of bacterial sexually transmitted infections has been advocated as an HIV prevention strategy.Aim: To inform screening guidelines, the incidence and risk factors for urethral and anal gonorrhoea and chlamydia were studied in a prospective cohort of community-based HIV negative homosexual men in Sydney, New South Wales, Australia.Methods: All participants were offered annual screening for gonorrhoea and chlamydia (study-visit diagnoses) on urine and anal swabs using nucleic acid amplification. Participants also reported diagnoses of gonorrhoea and chlamydia made elsewhere between interviews (interval diagnoses). All diagnoses were summed to create a combined incidence rate, and detailed data on specific sexual practices with casual and regular partners were collected.Results: Among 1427 men enrolled, the combined incidence rates were 3.49 and 2.96 per 100 person-years for urethral and anal gonorrhoea, respectively; and 7.43 and 4.98 per 100 person-years for urethral and anal chlamydia, respectively. Urethral infections were associated with unprotected anal intercourse (UAI) with HIV-positive partners (hazard ratio (HR) = 2.58, 95% CI 1.10 to 6.05 for urethral gonorrhoea) and with frequent insertive oral sex (p for trend 0.007 for urethral chlamydia). Anal infections were associated with receptive UAI (p for trend 0.001 for both anal gonorrhoea and chlamydia) and other receptive anal sexual practices. Stratified analyses showed the independence of the associations of insertive oral sex with urethral infections and of non-intercourse receptive anal practices with anal infections.Conclusion: Incident gonorrhoea and chlamydia were common. Risk behaviours for both urethral and anal infections were not restricted to UAI. Screening that includes tests for anal and urethral infections should be considered for all sexually active homosexual men, not just for those who report UAI. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the risk of non-Hodgkin lymphoma (NHL) using a job-exposure matrix (JEM) to assess exposure to occupational magnetic fields at the power frequencies of 50/60 Hz. Methods: The study population consisted of 694 cases of NHL, first diagnosed between 1 January 2000 and 31 August 2001, and 694 controls from two regions in Australia, matched by age, sex and region of residence. A detailed occupational history was given by each subject. Exposure to power frequency magnetic fields was estimated using a population-based JEM which was specifically developed in the United States to assess occupational magnetic field exposure. The cumulative exposure distribution was divided into quartiles and adjusted odds ratios were calculated using the lowest quartile as the referent group. Results: For the total work history, the odds ratio (OR) for workers in the upper quartile of exposure was 1.48 (95% CI 1.02 to 2.16) compared to the referent (p value for trend was 0.006). When the exposure was lagged by 5 years the OR was 1.59 (95% CI 1 .07 to 2.36) (p value for trend was 0.003). Adjusting for other occupational exposures did not significantly alter the results. Conclusions: These findings provide weak support for the hypothesis that occupational exposure to 50/60 Hz magnetic fields increases the risk of NHL. [ABSTRACT FROM AUTHOR]

This paper reports on the breaking of agreements between regular partners among HIV-negative gay men in Sydney. Data were from the 1333 men completing face-to-face interviews through December 2003 for the Health in Men (HIM) open cohort of HIV-negative gay men in Sydney. 822 men had a primary regular partner during the six month period before their 2003 interview. Most of these men had entered into agreements with their partners about sex either with each other or with other partners (87.2%). They most commonly agreed not to use condoms with each other (50.6%). Regarding casual sex, they most commonly agreed to always use condoms (34.2%) or to have no sex with men outside their relationships (28.6%). 48.8% reported some discomfort discussing with their partner their sex outside the relationship. Among those with agreements with their partners, 27.7% reported ever breaking those agreements. Those who found it more difficult to discuss issues of HIV serostatus and sexuality were more likely to report having broken their agreements ( p <.001; p =.021 at one-year follow-up) and were more likely to have engaged in unprotected anal intercourse with casual partners ( p <.001). A third of those men who broke their agreements did not inform their partner. A substantial proportion of gay men with agreements with their regular partners report some discomfort discussing sexuality and HIV serostatus with their partners. Difficulty discussing these issues may place these men at increased risk of breaking their agreements and may place both themselves and their partners at increased risk of infection. [ABSTRACT FROM AUTHOR]

To analyse clinical features and predictors of survival for AIDS-related non-Hodgkin's lymphoma (NHL) in the era of highly active antiretroviral therapy (HAART), compared to earlier in the HIV epidemic.All AIDS-NHL cases diagnosed at three inner Sydney hospitals caring for people with AIDS during 1985–2001 were identified through medical record searches. Demographic, clinical, immunological and histopathological information was recorded. Year of NHL diagnosis was grouped into three periods, corresponding to whether monotherapy (1985–1991), dual therapy (1992–1995) or HAART (1996–2001) was the main treatment for HIV infection. Statistical comparisons were made between the pre-HAART and post-HAART eras.Three hundred cases of AIDS-NHL were identified. Divergent trends were identified for systemic and primary central nervous system (CNS) NHL. For systemic NHL, the CD4 count at NHL diagnosis increased markedly to 208 cells/μL in the post-HAART era (P=0.014) and there was a trend towards presentation as the first AIDS-defining illness (69%,P=0.053), and as earlier stage NHL disease (42%,P=0.048). Median survival time increased from 4.2 months in 1985–1991 to 19 months in the post-HAART era (P<0.001). In a multivariate model, predictors of poor survival from systemic NHL included: NHL diagnosis after another AIDS-defining illness (P<0.001), stage 4 NHL (P<0.001), presentation at extra lymphatic sites (P=0.001), and nonreceipt of chemotherapy (P=0.002). After adjusting for the factors, those diagnosed in the era of HAART had a significant 56% reduction in rate of death (P<0.001). In contrast, for CNS NHL, clinical features were little changed and survival did not improve in the era of HAART.Systemic NHL is presenting earlier in the course of HIV disease, and at a less advanced NHL stage. There has been a marked improvement in survival in the era of HAART even after adjustment for other prognostic variables. In contrast, primary CNS NHL remains a disease which presents late in the course of HIV infection and is associated with a very poor prognosis. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess whether treatment with antiretroviral drugs within the first 3 months of infection with HIV affects medium-term health outcomes. DESIGN AND METHODS: Data from 20 cohorts in Europe and Australia were used Concerted Action on SeroConversion to AIDS and Death in Europe (CASCADE). Analysis was restricted to persons seroconverting in 1988-1998 who started antiretroviral treatment in the first 3 months or 1-2 years from seroconversion. The relationship between times to low CD4 count, AIDS and death and time of initiation of treatment was estimated using proportional hazards models. RESULTS: Seroconversion illness was more common in those who began antiretroviral treatment in the first 3 months (73%) than in those who started treatment within 1-2 years post-seroconversion (33%). Subjects receiving early antiretroviral treatment had times to AIDS and to CD4 counts <200 cells/microL that were intermediate between those of subjects starting treatment within 1-2 years and those of the subset of these subjects starting treatment within 1-2 years who also had a prior CD4 count of >350 cells/microL and no prior AIDS diagnosis. CONCLUSIONS: On the basis of these analyses, the effect of antiretroviral treatment initiation during HIV seroconversion is uncertain. It may result in lower rates of progression compared with starting antiretroviral treatment at 1-2 years, but the early antiretroviral treatment group had a similar or even higher incidence of low CD4 counts and AIDS events than the group who started antiretroviral treatment within 1-2 years with CD4 counts over 350 cells/microL and no prior AIDS diagnosis. Estimates of the effect of early treatment are probably confounded with a number of factors, including, in particular, reasons for treatment initiation. [ABSTRACT FROM AUTHOR]

This paper describes the prevalence of, and risk factors for, exposure to syphilis in a random sample of male and female prisoners. We found that only 2% of male and 1% of female prison inmates in New South Wales (NSW) had confirmed evidence of untreated syphilis, and none appeared to be in an infectious phase. In the multivariate analysis, indigenous ethnicity remained the most potent predictor for confirmed syphilis (either past or present). There was some evidence to suggest that syphilis among indigenous prisoners may be associated with limited access to health services outside prison. The epidemiology of syphilis reflects that of the general community suggesting that prisons could be used as sentinel sites to help evaluate the effectiveness of STD prevention and control strategies. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors for incident sexually transmitted infections (STI) in a remote Aboriginal community in Australia.Design: A population based cohort study.Setting: An Aboriginal community in central Australia.Participants: 1034 Aboriginal people aged 12-40 years, resident in the study region, seen during the period 1 January 1996 to 30 June 1998 for STI diagnosis.Main Outcome Measures: Incident rate of gonorrhoea, chlamydia, and syphilis per 100 person years.Results: There were 313 episodes of incident gonorrhoea, 240 of incident chlamydial infection, and 17 of incident syphilis. For gonorrhoea, risk factors were age, substance abuse, and previous prevalent chlamydial infection with a rate ratio (RR) of 3.2 in people aged 15-19 years, 1.6 in people who abused alcohol, and 3.2 in women who had sniffed petrol on a regular basis. For chlamydia, risk factors were sex, age, and a previous history of STI with a RR of 2.7 in people aged 15-19 years. Similar factors were associated with an increased risk of syphilis but the associations were not statistically significant.Conclusion: This study identified objective predictors of incident STI which can be used to target interventions and maximise their impact. The results of this study may well have relevance to indigenous communities in other countries that are faced with high levels of STI and substance abuse. [ABSTRACT FROM AUTHOR]

We aimed to create an improved, clinically-based algorithm for the diagnosis of HIV in tuberculosis (TB) patients. Cross-sectional analysis was performed on data from adult TB patients consecutively diagnosed at a Malawian district level hospital. Of 225 patients, 187 with valid HIV results were included in the study. Sixty-seven per cent were HIV seropositive. Urban address, history of skin rash and sexually transmitted diseases (STDs) and, on examination, oral candidiasis and lymphadenopathy, were associated with HIV co-infection. Using these clinical characteristics, a case definition for HIV was constructed. The Mzuzu clinical case definition was highly sensitive (86%). The area under the receiver operating characteristic (ROC) curve was 0.81, significantly larger than existing World Health Organization (WHO) clinical case definitions. The Mzuzu definition is proposed for further evaluation in settings where HIV serological testing is not readily available. [ABSTRACT FROM AUTHOR]