Abstract
Background: Surveillance of recent HIV infections (RHI) using an avidity assay has been implemented at Dutch sexual health centres (SHC) since 2014, but data on RHI diagnosed at other test locations is lacking.Setting: Implementation of the avidity assay in HIV treatment clinics for the purpose of studying RHI among HIV patients tested at different test locations.Methods: We retrospectively tested leftover specimens from newly diagnosed HIV patients in care in 2013–2015 in Amsterdam. Avidity Index (AI) values ≤0.80 indicated recent infection (acquired ≤6 months prior to diagnosis), and AI > 0.80 indicated established infection (acquired >6 months prior to diagnosis). An algorithm for RHI was applied to correct for false recency. Recency based on this algorithm was compared with recency based on epidemiological data only. Multivariable logistic regression analysis was used to identify factors associated with RHI among men who have sex with men (MSM).Results: We tested 447 specimens with avidity; 72% from MSM. Proportions of RHI were 20% among MSM and 10% among heterosexuals. SHC showed highest proportions of RHI (27%), followed by GPs (15%), hospitals (5%), and other/unknown locations (11%) (p < 0.001). Test location was the only factor associated with RHI among MSM. A higher proportion of RHI was found based on epidemiological data compared to avidity testing combined with the RHI algorithm.Conclusion: SHC identify more RHI infections compared to other test locations, as they serve high-risk populations and offer frequent HIV testing. Using avidity-testing for surveillance purposes may help targeting prevention programs, but the assay lacks robustness and its added value may decline with improved, repeat HIV testing and data collection.
Highlights
In January 2014, the National Institute for Public Health and the Environment (RIVM) implemented a biomarkerassay (Architect avidity) to distinguish recently acquired HIV infections (≤6 months prior to diagnosis) from established HIV infections in routine HIV surveillance at sexual health centers (SHCs) in the Netherlands [1, 2]
The samples were tested with the avidity assay and subsequently corrected for false recency with the RITA algorithm of the ECDC, that includes the clinical data of AIDS-defining illness, CD4 count, and viral load [17]
We compared the performance of this algorithm for biomarker-assays with routinely collected epidemiological data only that can be used as indicators for recent infection, such as [1] the date of the last negative HIV test in the past 6 months, [2] CD4 of ≥500 cells/mm3 at diagnosis as described by Le Guillou et al [18] reclassified as established infection in presence of AIDS-defining illnesses or viral load (
Summary
Surveillance of recent HIV infections (RHI) using an avidity assay has been implemented at Dutch sexual health centres (SHC) since 2014, but data on RHI diagnosed at other test locations is lacking. Setting: Implementation of the avidity assay in HIV treatment clinics for the purpose of studying RHI among HIV patients tested at different test locations
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