No Time to Delay! Fiebig Stages and Referral in Acute HIV infection: Seattle Primary Infection Program Experience

Abstract

There has been increasing recognition of the importance of diagnosing individuals during the earliest stages of human immunodeficiency virus (HIV) infection. Sera from individuals referred to a primary HIV infection research program were screened using the IgG-sensitive Vironostika HIV-1 Microelisa System, IgG/IgM-sensitive GS HIV-1/HIV-2 Plus O antibody enzyme immunoassay (EIA), or Abbott ARCHITECT HIV antigen (Ag)/antibody (Ab) Combo assay and confirmed by the Bio-Rad Multispot and Western blot. A subset of participants was co-enrolled in a study designed to compare the ability of point-of-care tests to detect early infection. We calculated time within primary infection laboratory stages using actual observed transitions and with an expectation-maximization algorithm. Three hundred and sixty participants contributed data to this analysis. Of 123 persons referred with EIA-negative/RNA-positive test results (Fiebig stage I-II) or for concern for symptoms, 24 (20%) were still in stages I-II, and 99 (80%) were in stages III or later at their screening visit. Participants were estimated to spend a median of 13.5 days in stages I and II, 2.3 days in stage III, and 7.8 days in stage IV. OraQuick performed on oral fluids detected 53% of 17 participants in stage V. The durations of stages we observed are consistent with previous publications. Most persons referred for research no longer had acute infection at their first visit. Programs wishing to identify persons in the very earliest stages of infection need to expedite referrals or develop targeted screening programs.

Transmitted HIV drug resistance and subtype patterns among blood donors in Poland

“…This is in line with the previous reports from Poland for the years 2001–2007 51 , however in our study calculation of HIV recency was based solely on the HIV-RNA, p24 and Western-blot patterns, with no implementation of the Recent Infection Testing Algorithm (RITA) assays. Donor testing is obviously intended to ensure blood safety, but it should not be overlooked that early HIV diagnosis in the cohort of blood donors in the setting of the low populational testing prevalence 52 allows for the rapid antiretroviral treatment initiation, reduction of infectivity and risk of onward transmissions 21 , 50 .…”

“…Data collected included type of donation (first time vs. repeated), gender, age, nationality, time since last donation (if repeated donor) and HIV infection (Fiebig) stage 20 , 21 . Fiebig stage was assessed based on the HIV molecular markers (HIV-RNA), p24 antigen, enzyme immunoassay reactivity and Western-blot patterns.…”

Poststudy Point-of-Care Oral Fluid Testing in Human Immunodeficiency Virus-1 Vaccinees

“…For in-home testing, the OraQuick In-Home HIV Test, available for over-the-counter purchase, would be used, and per the package insert, the test missed identifying 8 of 96 individuals with HIV infection (1 in 12), and it is to be used no less than 3 months after a potential exposure [ 38 ]. The test has insufficient sensitivity for detecting HIV infection during this time period [ 39 ]. There may also be delays in the appearance of HIV-1-specific antibodies associated with the use of antiretrovirals for pre-exposure prophylaxis [ 40 ].…”

Cohort profile: the Netherlands Cohort Study on Acute HIV infection (NOVA), a prospective cohort study of people with acute or early HIV infection who immediately initiate HIV treatment

“…29 The challenge to rapidly enrol participants diagnosed with Fiebig stages I and II has been described by others, and a delay between diagnosis and enrolment often results in participants no longer being in this phase of infection at enrolment. 31 We will continue to focus on accelerated diagnostic and referral pathways in collaboration with STI clinics, general practitioners and hospitals in order to increase the number of participants in these early infection stages. Unfortunately, for 5% of participants, there was no sample available in the window 3 days before or after cART initiation, and we used an estimated Fiebig stage rather than a measured Fiebig stage for these participants.…”