Altmetric

Clinical and public health implications of acute and early HIV detection and treatment: a scoping review

Title: Clinical and public health implications of acute and early HIV detection and treatment: a scoping review
Authors: Rutstein, SE
Ananworanich, J
Fidler, S
Johnson, C
Sanders, EJ
Sued, O
Saez-Cirion, A
Pilcher, CD
Fraser, C
Cohen, MS
Vitoria, M
Doherty, M
Tucker, JD
Item Type: Journal Article
Abstract: Introduction: The unchanged global HIV incidence may be related to ignoring acute HIV infection (AHI). This scoping review examines diagnostic, clinical, and public health implications of identifying and treating persons with AHI. Methods: We searched PubMed, in addition to hand-review of key journals identifying research pertaining to AHI detection and treatment. We focused on the relative contribution of AHI to transmission and the diagnostic, clinical, and public health implications. We prioritized research from low- and middle-income countries (LMICs) published in the last fifteen years. Results and Discussion: Extensive AHI research and limited routine AHI detection and treatment have begun in LMIC. Diagnostic challenges include ease-of-use, suitability for application and distribution in LMIC, and throughput for high-volume testing. Risk score algorithms have been used in LMIC to screen for AHI among individuals with behavioural and clinical characteristics more often associated with AHI. However, algorithms have not been implemented outside research settings. From a clinical perspective, there are substantial immunological and virological benefits to identifying and treating persons with AHI – evading the irreversible damage to host immune systems and seeding of viral reservoirs that occurs during untreated acute infection. The therapeutic benefits require rapid initiation of antiretrovirals, a logistical challenge in the absence of point-of-care testing. From a public health perspective, AHI diagnosis and treatment is critical to: decrease transmission via viral load reduction and behavioural interventions; improve pre-exposure prophylaxis outcomes by avoiding treatment initiation for HIV-seronegative persons with AHI; and, enhance partner services via notification for persons recently exposed or likely transmitting. Conclusions: There are undeniable clinical and public health benefits to AHI detection and treatment, but also substantial diagnostic and logistical barriers to implementation and scale-up. Effective early ART initiation may be critical for HIV eradication efforts, but widespread use in LMIC requires simple and accurate diagnostic tools. Implementation research is critical to facilitate sustainable integration of AHI detection and treatment into existing health systems and will be essential for prospective evaluation of testing algorithms, point-of-care diagnostics, and efficacious and effective first-line regimens.
Issue Date: 28-Jun-2017
Date of Acceptance: 29-May-2017
URI: http://hdl.handle.net/10044/1/50029
DOI: https://dx.doi.org/10.7448/IAS.20.1.21579
ISSN: 1758-2652
Publisher: International AIDS Society
Journal / Book Title: Journal of the International AIDS Society
Volume: 20
Copyright Statement: © 2017 Rutstein ER et al; licensee International AIDS Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution 3.0 Unported (CC BY 3.0) License ( http://creativecommons.org/licenses/by/3.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Sponsor/Funder: Imperial College Healthcare NHS Trust- BRC Funding
MRC DCS
Medical Research Council (MRC)
Merck Sharp & Dohme Ltd.
Funder's Grant Number: RDA02 79560
n/a
8101898808
Keywords: Science & Technology
Life Sciences & Biomedicine
Immunology
Infectious Diseases
acute HIV infection
antiretroviral therapy
diagnostics
early HIV
guidelines
low- and middle-income countries
primary HIV
SUB-SAHARAN AFRICA
SEXUALLY-TRANSMITTED INFECTION
EARLY ANTIRETROVIRAL THERAPY
ADULTS SEEKING CARE
AG/AB COMBO TEST
T-CELL COUNTS
VIRAL-LOAD
PREEXPOSURE PROPHYLAXIS
COST-EFFECTIVENESS
UNITED-STATES
1199 Other Medical And Health Sciences
Publication Status: Published
Article Number: ARTN 21579
Appears in Collections:Department of Medicine
Faculty of Medicine
Epidemiology, Public Health and Primary Care



Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Creative Commonsx