Abstract
BackgroundRecent studies have shown the public health importance of identifying acute HIV infection (AHI) in the men who have sex with men (MSM) of China, which has a much higher risk of HIV transmission. However, cost-utility analyses to guide policy around AHI screening are lacking.Methodology/Principal FindingsAn open prospective cohort was recruited among MSM living in Liaoning Province, Northeast China. Blood samples and epidemiological information were collected every 10 weeks. Third-generation ELISA and rapid test were used for HIV antibody screening, western blot assay (WB) served for assay validation. Antibody negative specimens were tested with 24 mini-pool nucleic acid amplification testing (NAAT). Specimens with positive ELISA but negative or indeterminate WB results were tested with NAAT individually without mixing. A cost-utility analysis of NAAT screening was assessed. Among the 5,344 follow-up visits of 1,765 MSM in 22 months, HIV antibody tests detected 114 HIV chronic infections, 24 seroconverters and 21 antibody indeterminate cases. 29 acute HIV infections were detected with NAAT from 21 antibody indeterminate and 1,606 antibody negative cases. The HIV-1 prevalence and incidence density were 6.6% (95% CI: 5.5–7.9) and 7.1 (95% CI: 5.4–9.2)/100 person-years, respectively. With pooled NAAT and individual NAAT strategy, the cost of an HIV transmission averted was $1,480. The addition of NAAT after HIV antibody tests had a cost-utility ratio of $3,366 per gained quality-adjusted life year (QALY). The input-output ratio of NAAT was about 1∶16.9.Conclusions/SignificanceThe HIV infections among MSM continue to rise at alarming rates. Despite the rising cost, adding pooled NAAT to the HIV antibody screening significantly increases the identification of acute HIV infections in MSM. Early treatment and target-oriented publicity and education programs can be strengthened to decrease the risk of HIV transmission and to save medical resources in the long run.
Highlights
Recent data indicate that human immunodeficiency virus (HIV) infections have been rising sharply among the men who have sex with men (MSM) high-risk population in China [1,2,3,4,5]
The 21 cases were all positive in nucleic acid amplification testing (NAAT) and were diagnosed acute HIV infections due to an increase of bands in their follow-up samples confirmed with western blot assay (WB)
No changes in HIV specific bands were detected in follow-up samples; these 3 cases were considered to be false positives for HIV antibody screening
Summary
Recent data indicate that human immunodeficiency virus (HIV) infections have been rising sharply among the men who have sex with men (MSM) high-risk population in China [1,2,3,4,5]. In a recent large-scale national survey conducted in 2008 across 61 cities throughout China, covering over 18,000 MSM, the prevalence of human immunodeficiency virus (HIV) was 4.9% and incidence ranged from 2.6 to 5.4 per 100 person-years [6]. Recent studies have shown the public health importance of identifying acute HIV infection (AHI) in the men who have sex with men (MSM) of China, which has a much higher risk of HIV transmission. Cost-utility analyses to guide policy around AHI screening are lacking
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