Abstract
To assess the use of fourth-generation rapid diagnostic tests in identifying acute infection of Human Immunodeficiency Virus (HIV). BCN Checkpoint promotes sexual health among men who have sex with men (MSM), with a focus on diagnosing HIV early, initiating combined antiretroviral treatment (cART) promptly, and recommending regular repeat testing for those who have tested negative. This cross-sectional study included all test results obtained at the centre between 25 March 2016 and 24 March 2019. The Alere™ HIV Combo (now rebranded to Determine™ HIV Ultra, from Abbott) was used to detect p24 antigen (p24 Ag) and/or immunoglobulin M (IgM) and G (IgG) antibodies to HIV-1/HIV-2 (HIV Ab). Rapid polymerase chain reaction (PCR) confirmatory testing and Western blot (WB) were performed for clients with a positive rapid test result. Confirmed HIV cases were promptly referred to the HIV unit for care and cART prescription. A total of 12,961 clients attended BCN Checkpoint during the study and 27,298 rapid tests were performed. 450 tests were found to be reactive, of which 430 confirmed as HIV-positive, representing a prevalence of 3.32%. Four confirmed cases (0.93%) were detected as "p24 Ag only", nine (2.09%) as "both p24 and HIV Ab" and 417 (96.98%) as "HIV Ab only". The "p24 Ag only" group had a 1-log higher viral load than the other groups and initiated treatment on the following working day. Overall, there were 20 false-positive results (0.07% and 4.44% of total and reactive tests, respectively), of which 10 positive for "p24 Ag only" and 10 for "HIV Ab only". Four Acute HIV Infections (AHI), with very high viral loads, have been detected with the "p24 Ag only" while the HIV Ab were still absent. Referral to the HIV unit and initiation of cART on the following working day contributed to improving persons' health and to reduce HIV transmission chain.
Highlights
The Human Immunodeficiency Virus (HIV) epidemic has become an endemic infection
Another 197 people were newly diagnosed with HIV, of which 63% were men who have sex with men (MSM) [2]
In that same year in London 33,436 people were estimated to be living with HIV and the number of new HIV diagnoses was 1,549, of which 63% were MSM [3]
Summary
The HIV epidemic has become an endemic infection. It is one of the world’s most serious public health challenges that need a global commitment to stopping new HIV infections and ensuring that everyone has access to HIV treatment. In the last three decades, over 2.3 million people have been diagnosed with HIV in the European region, according to World Health Organization estimates [2]. In 2017, a total of 159,429 individuals were newly diagnosed in 50 out of 53 countries of the European region, which equals a rate of 20 new HIV diagnoses per 100,000 residents. Another 197 people were newly diagnosed with HIV, of which 63% were men who have sex with men (MSM) [2]. In that same year in London 33,436 people were estimated to be living with HIV and the number of new HIV diagnoses was 1,549, of which 63% were MSM [3]. In 2017 in Barcelona, 352 cases were detected, of which 82.5% were MSM [4]
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