Impact of nucleic acid testing relative to antigen/antibody combination immunoassay on the detection of acute HIV infection

Souza, de; Phanuphak, Nittaya; Pinyakorn, Suteeraporn; Trichavaroj, Rapee; Pattanachaiwit, Supanit; Chomchey, Nitiya; Jl, Fletcher; Ed, Kroon; Michael, NL; Phanuphak, Praphan; Kim, Jae‐Hun; Ananworanich, Jintanat

doi:10.1097/qad.0000000000000616

Cited by 76 publications

(89 citation statements)

References 30 publications

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“…We included individuals diagnosed with acute HIV infection (AHI) from the previously described SEARCH 010/RV254 cohort in Bangkok, Thailand [35]. Study participants sought elective HIV testing at the Thai Red Cross Anonymous HIV clinic or were men who have sex with men (MSM) enrolled in a study at the Silom Community Clinic, both in Bangkok.…”

Section: Methodsmentioning

confidence: 99%

Depression and Anxiety are Common in Acute HIV Infection and Associate with Plasma Immune Activation

et al. 2017

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This observational study of 123 Thai participants sought to determine the rate and severity of affective symptoms during acute HIV infection (AHI) and possible associations to disease mechanisms. At diagnosis, just prior to starting combination antiretroviral therapy (cART), AHI participants completed assessments of depression and anxiety symptoms that were repeated at 4, 12, and 24 weeks. Blood markers of HIV infection and immune activation were measured at study entry, with optional cerebrospinal fluid (CSF) measures. A high frequency of participants reported symptoms that exceeded published thresholds supportive of depression (55.0%) and anxiety (65.8%) at diagnosis, with significant reductions after starting cART. Meeting a threshold for clinically relevant depressive symptoms at study entry was associated with higher baseline plasma HIV RNA (5.98 vs. 5.50, t=2.46, p=0.015), lower CD4 counts (328 vs. 436 cells/mm3, t=3.46, p=0.001), and higher plasma neopterin, a marker of macrophage activation (2694 vs. 1730 pg/mL, Mann-Whitney U = 152.5, p=0.011). Controlling for plasma HIV RNA and CD4 count, higher baseline plasma neopterin correlated with worse initial depression and anxiety scores. Depression and anxiety symptoms are frequent in acute HIV infection, associate with plasma immune activation, and can improve concurrent with cART.

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Section: Methodsmentioning

confidence: 99%

Depression and Anxiety are Common in Acute HIV Infection and Associate with Plasma Immune Activation

et al. 2017

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“…This window is especially critical window for persons with AHI, and this opportunity will be missed if mechanisms to prioritize and urgently start ART in acutely-infected individuals are not in place. Same-day ART has been successfully implemented in low and middle income countries (31, 99). There are substantial financial, technical, and logistical barriers involved in AHI diagnosis, linkage, and treatment; but revision of international guidelines is essential in order to begin to address these obstacles ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…in the first two weeks of infection), and pooled specimen throughput and costs may be more suitable for AHI screening in resource-limited settings. In high- and low-prevalence settings, pooled NAT substantially increases the number of persons identified with AHI compared to standalone 4 th generation testing (31, 32). Although pooling for AHI may be cost-effective (33), financial feasibility will depend on the underlying prevalence of AHI and specific pooling strategy.…”

Section: Diagnosis Of Acute Hiv Infectionmentioning

confidence: 99%

“…Ideal pooling strategies maximize batch size according to population risk profiles and HIV prevalence, with a tradeoff of increased complexity with larger pools. In a high-prevalence Thai cohort, addition of pooled NAT after 4 th generation testing increased acute diagnosis by nearly 40% but also increased screening costs by 22% (31). Besides costs, laboratory-based assays introduce logistical barriers to AHI screening, requiring venipuncture and patient follow-up…”

Section: Diagnosis Of Acute Hiv Infectionmentioning

confidence: 99%

“…An AHI study in New York City reports similar rates between patients newly diagnosed with AHI and established HIV of linkage within 3 months (92% vs 91%) retention at 12 months (86% vs 83%, p= 0.78) and suppression (65% vs 60%) (81). Additionally, a recent study reports 111/112 participants diagnosed with AHI at a Thai clinic were initiated on ART at their first care visit, a median of 19 days from the estimated date of their exposure to HIV, with excellent subsequent retention and viral suppression outcomes (31). Other studies involving rapid linkage and ART initiation are currently in process (MP3, SEARCH, rapIT, Brigham/GHESKIO, Engage4Health, all clinicaltrials.gov).…”

Section: Leveraging the Acute Hiv Cascade For Preventionmentioning

confidence: 99%

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The HIV treatment cascade in acutely infected people

Rutstein¹,

Sellers²,

Ananworanich

et al. 2015

Current Opinion in HIV and AIDS

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Purpose of Review Acute and early HIV (AHI) is a pivotal time during HIV infection, yet there remain major shortfalls in diagnosis, linkage to care, and antiretroviral therapy (ART) initiation during AHI. We introduce an AHI-specific cascade, review recent evidence pertaining to the unique challenges of AHI, and discuss strategies for improving individual and public health outcomes. Recent Findings Presentation during AHI is common. Expanding use of 4th generation testing and pooled nucleic acid amplification testing (NAT) has led to improved AHI detection in resource-wealthy settings. Technologies capable of AHI diagnosis are rare in resource-limited settings; further development of point-of-care devices and utilization of targeted screening is needed. Rapid ART initiation during AHI limits reservoir seeding, preserves immunity, and prevents transmission. Reporting of AHI cascade outcomes is limited, but new evidence suggests that impressive rates of diagnosis, linkage to care, rapid ART initiation, and viral suppression can be achieved. Summary With advancements in AHI diagnostics and strong evidence for the therapeutic and prevention benefits of ART initiated during AHI, improving AHI cascade outcomes is both crucial and feasible. HIV guidelines should recommend diagnostic algorithms capable of detecting AHI and prescribe rapid, universal ART initiation during AHI.

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Screening Yield of HIV Antigen/Antibody Combination and Pooled HIV RNA Testing for Acute HIV Infection in a High-Prevalence Population

Peters

Westheimer

Cohen

et al. 2016

JAMA

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Impact of nucleic acid testing relative to antigen/antibody combination immunoassay on the detection of acute HIV infection

Cited by 76 publications

References 30 publications

Depression and Anxiety are Common in Acute HIV Infection and Associate with Plasma Immune Activation

Depression and Anxiety are Common in Acute HIV Infection and Associate with Plasma Immune Activation

The HIV treatment cascade in acutely infected people

Screening Yield of HIV Antigen/Antibody Combination and Pooled HIV RNA Testing for Acute HIV Infection in a High-Prevalence Population

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