A simple algorithm for selecting cases to investigate acute and early HIV infections in low- and middle-income countries.

Elaine Monteiro Matsuda,Daniela Rodrigues Colpas,Giselle Ibete Silva López‐Lopes,Ivana Barros Campos,Isabela Penteriche De Oliveira,Cintia Mayumi Ahagon,Valeria Oliveira Silva,Luana Portes Ozório Coelho,Luís Fernando De Macedo Brígido,Norberto Camilo Campos

doi:10.1002/jmv.27398

Elaine Monteiro Matsuda, Daniela Rodrigues Colpas + Show 8 more

Open Access

https://doi.org/10.1002/jmv.27398

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Abstract

We documented the outcome of an over 10-year (2011-2021) effort to diagnose acute and early HIV infections (AEHI) in an Infectious Diseases Outpatient Clinic with limited resources. Of a total of 132, 119 HIV-RNA tests were performed from 2017 to 2020, 12 cases were identified, using a simple algorithm: risk exposure of 6 weeks or less before the visit and/or symptoms compatible with acute retroviral syndrome 7-30 days after exposure and/or undetermined 3rd generation rapid diagnostic test or serology. AEHI diagnoses varied from 2.4% among asymptomatic to 25% for undetermined serology cases using this simple screening applicable to different settings.

Highlights

The concept that individuals with viremia lower than 200 copies/mL do not transmit has led to support the strategy of universal treatment of the human immunodeficiency virus (HIV) for prevention of transmission (TasP– treatment as prevention) [1,2,3]
The implementation of strategies to diagnose acute and early HIV infections (AEHI) may significantly reduce the time between the diagnosis of HIV and viral suppression [6]. Targeting this population might be especially relevant as different studies suggest that 10% to 50% of HIV transmission events occur during AEHI [7,8,9,10]
It appears that the algorithm proposed was useful for case selection, as all but one, were diagnosed by HIVRNA tests in the AEHI had suspected symptoms of the acute retroviral syndrome in the last 30 days of collection. This one exception was screened due to a discordant RDT3. This young woman was the only AEHI identified among 41 asymptomatic individuals, an elite controller

Summary

Introduction

The concept that individuals with viremia lower than 200 copies/mL do not transmit has led to support the strategy of universal treatment of the human immunodeficiency virus (HIV) for prevention of transmission (TasP– treatment as prevention) [1,2,3]. The implementation of strategies to diagnose acute and early HIV infections (AEHI) may significantly reduce the time between the diagnosis of HIV and viral suppression [6].

Results

Conclusion