Six-week follow-up after HIV-1 exposure: a position statement from the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy

Abstract

In 2014 the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy (RAV) conducted a review and analysis of the state of knowledge on the duration of follow-up after exposure to human immunodeficiency virus (HIV). Up until then a follow-up of 12 weeks after exposure had been recommended, but improved tests and new information on early diagnosis motivated a re-evaluation of the national recommendations by experts representing infectious diseases and microbiology, county medical officers, the RAV, the Public Health Agency, and other national authorities. Based on the current state of knowledge the Public Health Agency of Sweden and the RAV recommend, starting in April 2015, a follow-up period of 6 weeks after possible HIV-1 exposure, if HIV testing is performed using laboratory-based combination tests detecting both HIV antibody and antigen. If point-of-care rapid HIV tests are used, a follow-up period of 8 weeks is recommended, because currently available rapid tests have insufficient sensitivity for detection of HIV-1 antigen. A follow-up period of 12 weeks is recommended after a possible exposure for HIV-2, since presently used assays do not include HIV-2 antigens and only limited information is available on the development of HIV antibodies during early HIV-2 infection. If pre- or post-exposure prophylaxis is administered, the follow-up period is recommended to begin after completion of prophylaxis. Even if infection cannot be reliably excluded before the end of the recommended follow-up period, HIV testing should be performed at first contact for persons who seek such testing.

Factors associated with loss to follow-up after occupational HIV exposure in Cape Town, South Africa: a retrospective cohort study

“…The WHO has recently advised the final follow-up visit should be at 3 months rather than 6 months [15]. Furthermore, it has been suggested that the last follow-up visit should be at 6 weeks if laboratory 4th generation HIV ELISA tests are utilized, and 8 weeks if 4th generation rapid HIV tests are utilized [34]. Lastly van der Maaten et al [9] suggested increasing awareness of the availability of PEP through campaigns.…”

Evaluation of tolerability with the co-formulation elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate for post-HIV exposure prophylaxis

“…Besides PEP prescription, good follow-up was previously found associated with older age and sexual encounter with a sex worker [19]. The completeness of HIV-testing follow-up could be increased by reducing the number of HIV testings with one HIV-serology testing 6 weeks after PEP completion, as proposed by the Swedish reference group for antiretroviral therapy [20], and targeting counseling to people receiving PEP.…”

Place and practice: Sexual risk behaviour while travelling abroad among Swedish men who have sex with men

“…About 25% of MSM report never having been HIV tested in every Swedish MSM survey over the past twenty years 2,42,43,94,146 . It has been possible to test for HIV since the mid-1980s 166 , and since the 1990s, studies on barriers to HIV testing have been conducted. Our factor analysis of barriers to HIV testing among MSM confirmed in many ways previous study findings showing that fear and anxiety 101,167 as well as structural factors specifically for subgroups of MSM [168][169][170] remain hindrances for testing.…”