HIV diagnosis during acute infection: implications of long-acting preexposure prophylaxis and other evolving challenges
Author(s)
Elliott, Tamara
Bradshaw, Daniel
Fidler, Sarah
Type
Journal Article
Abstract
Purpose of review
Tests for HIV may perform differently in some circumstances such as with preexposure prophylaxis (PrEP) or other HIV prevention agents. Testing algorithms may not account for this, with a risk of false negative or positive HIV results. In this review we have explored the challenges of HIV testing in these special circumstances.
Recent findings
Long-acting injectable PrEP using cabotegravir or lenacapavir has been studied in large randomized controlled trials (HPTN083/084 and PURPOSE1/2 respectively). Injectable PrEP was significantly more efficacious than oral PrEP, but infections still occurred risking the emergence of HIV drug-resistance. HIV diagnostic test results were atypical in those receiving injectable PrEP, with low or undetectable HIV viral loads, delayed or diminished antibody, and HIV detection assays reverting from reactive to unreactive; so-called long acting early viral inhibition (LEVI) syndrome. In these cases, missed or delayed HIV diagnoses could be reduced with the use of HIV nucleic acid amplification tests in addition to routine testing, but this remains unfeasible in many settings.
Summary
Finding HIV testing strategies that are affordable and practical in low- and middle-income countries that can accurately diagnose HIV in the context of HIV prevention is of high importance, but more research is needed in this area.
Tests for HIV may perform differently in some circumstances such as with preexposure prophylaxis (PrEP) or other HIV prevention agents. Testing algorithms may not account for this, with a risk of false negative or positive HIV results. In this review we have explored the challenges of HIV testing in these special circumstances.
Recent findings
Long-acting injectable PrEP using cabotegravir or lenacapavir has been studied in large randomized controlled trials (HPTN083/084 and PURPOSE1/2 respectively). Injectable PrEP was significantly more efficacious than oral PrEP, but infections still occurred risking the emergence of HIV drug-resistance. HIV diagnostic test results were atypical in those receiving injectable PrEP, with low or undetectable HIV viral loads, delayed or diminished antibody, and HIV detection assays reverting from reactive to unreactive; so-called long acting early viral inhibition (LEVI) syndrome. In these cases, missed or delayed HIV diagnoses could be reduced with the use of HIV nucleic acid amplification tests in addition to routine testing, but this remains unfeasible in many settings.
Summary
Finding HIV testing strategies that are affordable and practical in low- and middle-income countries that can accurately diagnose HIV in the context of HIV prevention is of high importance, but more research is needed in this area.
Date Issued
2025-05-01
Date Acceptance
2025-05-01
Citation
Current Opinion in HIV and AIDS, 2025, 20 (3), pp.228-235
ISSN
1746-630X
Publisher
Lippincott, Williams & Wilkins
Start Page
228
End Page
235
Journal / Book Title
Current Opinion in HIV and AIDS
Volume
20
Issue
3
Copyright Statement
Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0/
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/39964676
PII: 01222929-990000000-00138
Subjects
CISGENDER MEN
HIV preexposure prophylaxis
HIV prevention
HIV testing
Immunology
Infectious Diseases
INJECTABLE CABOTEGRAVIR
Life Sciences & Biomedicine
NEUTRALIZING ANTIBODIES
PHARMACOKINETICS
PREVENTION
SAFETY
Science & Technology
TOLERABILITY
TRIALS
UNINFECTED ADULTS
WOMEN
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2025-02-17