Immediate diagnosis of acute HIV infection (AHI) is important from both patient as well as public health perspective. First, patients benefit from immediate start of antiretroviral therapy (ART) during the early phase of infection. Second, AHI is an important cause of onward transmission given high viral load and unawareness of infection. The recent development of point-of-care HIV-RNA tests has made prompt diagnosis of AHI at time of care seeking possible. We implemented an on-going rapid AHI diagnostic and referral trajectory at the Amsterdam Public Health Service in 2015, including the use of a point-of-care HIV-RNA test. We present the first experiences with this new AHI trajectory.
Men who have sex with men (MSM) were assessed for eligibility after being referred by a media campaign through a dedicated website (hebikhiv.nl, with a self-referral screening tool), by their general practitioner (GP), or during routine STI screening at the Public Health Service. Eligibility was based on a score of symptoms in combination with condomless anal sex in the previous 3 months. If eligible, a rapid HIV antibody test was performed. If negative, both a point-of-care HIV-RNA test (GeneXpert, Cepheid) and a HIV antigen/antibody test (Murex on LiaisonXL) were performed. AHI was defined as an HIV-RNA positive test result and an antigen/antibody negative or only positive for antigen (Fiebig I-II) test result.
From August 2015 through September 2016, 192 MSM with possible AHI presented themselves for testing, of whom 157 men were eligible. Of these 157 men, 47.8% were referred by the website/campaign, 7.6% by their GP and 31.2% via routine STI screening. The median age was 33 years (IQR 26-43). The average time between intake and test results was 4 hours. In total, 14/157 men were newly diagnosed with HIV. Seven were diagnosed with AHI (Fiebig I-II), 5 with recent HIV infection (Fiebig III-V) and 2 with established HIV infection (Table). All 14 were referred to an HIV treatment center the same day for immediate start of ART.
The AHI trajectory resulted in a high prevalence (12/157; 7.6%) of acute or recent HIV infection. The addition of the point-of-care HIV-RNA test provided same-day results and early start of ART. Moreover, 2 extra cases of AHI were diagnosed relative to only using antigen/antibody assays. Further evaluation including (cost)effectiveness analyses will contribute to our knowledge of optimizing early diagnosis and immediate start of treatment.