scholarly journals A Strategy for PrEP Clinicians to Manage Ambiguous HIV Test Results During Follow-up Visits

2018 ◽  
Vol 5 (8) ◽  
Author(s):  
Dawn K Smith ◽  
William M Switzer ◽  
Philip Peters ◽  
Kevin P Delaney ◽  
Timothy C Granade ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Test Results ◽  
Hiv Status ◽  
Management Options ◽  
Hiv Test ◽  
Confirmatory Tests ◽  
Testing Algorithms ◽  
Effective Treatment Regimen ◽  
Exposure Prophylaxis

Abstract Prompt determination of HIV infection status is critical during follow-up visits for patients taking pre-exposure prophylaxis (PrEP) medication. Those who are uninfected can then continue safely taking PrEP, and those few who have acquired HIV infection can initiate an effective treatment regimen. However, a few recent cases have been reported of ambiguous HIV test results using common testing algorithms in PrEP patients. We review published reports of such cases and testing options that can be used to clarify true HIV status in these situations. In addition, we review the benefits and risks of 3 antiretroviral management options in these patients: (1) continue PrEP while conducting additional HIV tests, (2) initiate antiretroviral therapy for presumptive HIV infection while conducting confirmatory tests, or (3) discontinue PrEP to reassess HIV status after a brief antiretroviral-free interval. A clinical consultation resource is also provided.

scholarly journals Do I Have HIV or Not? Lack of RNA Detection and the Case for Sensitive DNA Testing

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Sandra A Springer ◽  
Silvina Masciotra ◽  
Jeffrey A Johnson ◽  
Sheldon Campbell
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Viral Rna ◽  
Infection Status ◽  
Test Results ◽  
Dna Testing ◽  
Rna Detection ◽  
Hiv Test

Abstract We present a case of a 20-year-old male who had ambiguous HIV test results after entering new provider care and whose status was later complicated by undetectable viral RNA off antiretroviral therapy (ART). Verifying HIV infection status may occasionally require sensitive DNA testing that might need to be considered in diagnostic guidelines to resolve diagnosis and ensure appropriate ART management.

scholarly journals Evaluation of HIV counselling and testing, self-disclosure, social support and sexual behaviour change among a rural sample of HIV reactive patients in South Africa

Curationis ◽  
2005 ◽  
Vol 28 (1) ◽  
Author(s):  
E Sethosa ◽  
K Peltzer
Keyword(s):  
Social Support ◽  
South Africa ◽  
Hiv Disclosure ◽  
Hiv Status ◽  
Self Disclosure ◽  
Hiv Test ◽  
Post Test ◽  
Hiv Counselling And Testing ◽  
Rural Sample

The aim of this study was to evaluate HIV counselling and testing, self-disclosure, social support and sexual behavior change among HIV reactive patients among a rural sample of HIV reactive patients in South Africa. The sample consisted at the post-test counselling exit interview of 55 participants (41 women and 14 men) who tested HIV-positive conveniently selected from a rural hospital and at five months follow-up at their homes 47. Results indicated that most patients had an HIV test because of medical reasons. At follow-up only 36% had disclosed their HIV status and half of the participants had had sex without condoms in the past three weeks. Major reason for not disclosing of their HIV status were being afraid of negative reactions, fear of discrimination, fear of violence, concerns about confidentiality and not yet ready. Social support was found to be significantly related to disclosure of HIV status, while counselling context and content and counselling satisfaction were not related with HIV disclosure.

scholarly journals Immediate PrEP after PEP: Results from an Observational Nurse-Led PEP2PrEP Study

2020 ◽  
Vol 19 ◽  
pp. 232595822093976
Author(s):  
Patrick O’Byrne ◽  
Lauren Orser ◽  
Amanda Vandyk
Keyword(s):  
Seroconversion Rate ◽  
Male Partner ◽  
Post Exposure Prophylaxis ◽  
Hiv Status ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Control And Prevention ◽  
Hiv Acquisition ◽  
Exposure Prophylaxis

Patients who use post-exposure prophylaxis (PEP) are at ongoing risk for HIV acquisition after completing PEP. While the Centers for Disease Control and Prevention recommends pre-exposure prophylaxis (PrEP) use immediately after PEP, some practitioners are hesitant to offer PEP-to-PrEP (PEP2PrEP). We began offering PEP2PrEP in the sexually transmitted infection clinic in Ottawa, Canada on August 5, 2018. During the first 16 months of PEP2PrEP, 61 patients requested PEP and 46 were initiated; 30 of these patients agreed to PEP2PrEP and 26 followed through. None of our PEP patients had confirmed HIV exposures; all fulfilled the initiation criterion of condomless anal sex with a male partner of unknown HIV-status. During the study, the number of PEP requests and initiations was statistical unchanged, yet the seroconversion rate among patients who used PEP decreased from 1.7% pre-PEP2PrEP to 0% post-PEP2PrEP. Regarding follow-up, most discontinuations occurred between the PrEP intake and 1-month follow-up visit.

scholarly journals Evaluation of Rapid Testing Algorithms for Venue-based Anonymous HIV Testing among Non-HIV-Positive Men Who Have Sex with Men, National HIV Behavioral Surveillance (NHBS), 2017

2020 ◽  
Vol 45 (6) ◽  
pp. 1228-1235
Author(s):  
Shamaya Whitby ◽  
◽  
Amanda Smith ◽  
Rebecca Rossetti ◽  
Johanna Chapin-Bardales ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Confirmatory Test ◽  
Test Results ◽  
Rapid Testing ◽  
Behavioral Surveillance ◽  
National Hiv Behavioral Surveillance ◽  
Hiv Test ◽  
Hiv Rapid Testing ◽  
Testing Algorithms ◽  
Sex With Men

Abstract HIV rapid testing algorithms (RTAs) using any two orthogonal rapid tests (RTs) allow for on-site confirmation of infection. RTs vary in performance characteristics therefore the selection of RTs in an algorithm may affect identification of infection, particularly if acute. National HIV Behavioral Surveillance (NHBS) assessed RTAs among men who have sex with men recruited using anonymous venue-based sampling. Different algorithms were evaluated among participants who self-reported never having received a positive HIV test result prior to the interview. NHBS project areas performed sequential or parallel RTs using whole blood. Participants with at least one reactive RT were offered anonymous linkage to care and provided a dried blood spot (DBS) for testing at CDC. Discordant results (RT-1 reactive/RT-2 non-reactive) were tested at CDC with lab protocols modified for DBS. DBS were also tested for HIV-1 RNA (VL) and antiretroviral (ARV) drug levels. Of 6500 RTAs, 238 were RT-1 reactive; of those, 97.1% (231/238) had concordant results (RT-1/RT-2 reactive) and 2.9% (7/238) had discordant results. Five DBS associated with discordant results were available for confirmation at CDC. Four had non-reactive confirmatory test results that implied RT-1 false reactivity; one had ambiguous confirmatory test results which was non-reactive in further testing. Regardless of order and type of RT used, RTAs demonstrated high concordant results in the population surveyed. Additional laboratory testing on DBS following discordant results confirmed no infection. Implementing RTAs in the context of anonymous venue-based HIV testing could be an option when laboratory follow-up is not practicable.

scholarly journals Prospective Evaluation of HIV Testing Technologies in a Clinical Setting: Protocol for Project DETECT (Preprint)

2019 ◽  
Author(s):  
Joanne D Stekler ◽  
Lauren R Violette ◽  
Hollie A Clark ◽  
Sarah J McDougal ◽  
Lisa A Niemann ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Prospective Study ◽  
Hiv Testing ◽  
Transmitted Disease ◽  
The United States ◽  
Test Results ◽  
Cross Sectional ◽  
Hiv Test ◽  
Hiv Acquisition ◽  
Hiv 1

BACKGROUND HIV testing guidelines provided by the Centers for Disease Control and Prevention (CDC) are continually changing to reflect advancements in new testing technology. Evaluation of existing and new point-of-care (POC) HIV tests is crucial to inform testing guidelines and provide information to clinicians and other HIV test providers. Characterizing the performance of POC HIV tests using unprocessed specimens can provide estimates for the window period of detection, or the time from HIV acquisition to test positivity, which allows clinicians and other HIV providers to select the appropriate POC HIV tests for persons who may be recently infected with HIV. OBJECTIVE This paper describes the protocols and procedures used to evaluate the performance of the newest POC tests and determine their sensitivity during early HIV infection. METHODS Project DETECT is a CDC-funded study that is evaluating POC HIV test performance. Part 1 is a cross-sectional, retrospective study comparing behavioral characteristics and HIV prevalence of the overall population of the Public Health–Seattle & King County (PHSKC) Sexually Transmitted Disease (STD) Clinic to Project DETECT participants enrolled in part 2. Part 2 is a cross-sectional, prospective study evaluating POC HIV tests in real time using unprocessed whole blood and oral fluid specimens. A POC nucleic acid test (NAT) was added to the panel of HIV tests in June 2018. Part 3 is a longitudinal, prospective study evaluating seroconversion sensitivity of POC HIV tests through serial follow-up testing. For comparison, HIV-1 RNA and HIV-1/HIV-2 antigen/antibody tests are also performed for participants enrolled in part 2 or 3. A behavioral survey that collects information about demographics, history of HIV testing, STD history, symptoms of acute HIV infection, substance use, sexual behaviors in the aggregate and with recent partners, and use of pre-exposure prophylaxis and antiretroviral therapy is completed at each part 2 or 3 visit. RESULTS Between September 2015 and March 2019, there were 14,990 Project DETECT–eligible visits (part 1) to the PHSKC STD Clinic resulting in 1819 part 2 Project DETECT study visits. The longitudinal study within Project DETECT (part 3) enrolled 27 participants with discordant POC test results from their part 2 visit, and 10 (37%) were followed until they had fully seroconverted with concordant positive POC test results. Behavioral survey data and HIV test results, sensitivity, and specificity will be presented elsewhere. CONCLUSIONS Studies such as Project DETECT are critical for evaluating POC HIV test devices as well as describing characteristics of persons at risk for HIV acquisition in the United States. HIV tests in development, including POC NATs, will provide new opportunities for HIV testing programs. INTERNATIONAL REGISTERED REPORT RR1-10.2196/16332

Does qualitative viral load testing shorten the window period for diagnosing HIV in individuals attending for post-exposure prophylaxis?

2020 ◽  
Vol 31 (9) ◽  
pp. 816-819
Author(s):  
Gary Whitlock ◽  
Nneka Nwokolo ◽  
Keyword(s):  
Viral Load ◽  
Hiv Infection ◽  
Point Of Care ◽  
Fourth Generation ◽  
Post Exposure Prophylaxis ◽  
Hiv Incidence ◽  
Post Exposure ◽  
Window Period ◽  
Hiv Test ◽  
Exposure Prophylaxis

A fourth-generation HIV test is conventionally performed at baseline for individuals given HIV post-exposure prophylaxis (PEP). However, early HIV infection may be missed by fourth-generation tests especially in settings of high HIV incidence, meaning that recently infected individuals are potentially at risk of transmitting HIV. In 2013, HIV incidence in PEP recipients at the 56 Dean Street clinic was 7.6 per 100 person-years. We therefore wished to see if using a point-of-care PCR HIV test in such individuals would shorten the testing window period and pick up early infections that would be undiagnosed by conventional tests. We compared HIV detection in PEP recipients using the Cepheid GeneXpert® HIV-1 Qual viral load (Qual VL) assay with the standard HIV tests used in our clinical service. Between March 2017 and August 2018, a Qual VL assay was performed in addition to standard baseline HIV tests in consented PEP recipients. Of 494 consented PEP recipients, 476 had valid Qual VL assay results. Of these, 474 (99.6%) had a negative Qual VL result and were also negative on standard baseline HIV tests. Two (0.4%) tested positive for HIV on Qual VL. One of these patients was also HIV-positive on all baseline HIV tests. The other had discordant baseline point-of-care HIV test results. Although no additional HIV infections were diagnosed in PEP recipients using Qual VL, in one individual, it provided confirmation of new HIV infection more quickly than the standard HIV testing pathway.

scholarly journals Lack of Awareness of Human Immunodeficiency Virus (HIV) Infection: Problems and Solutions With Self-reported HIV Serostatus of Men Who Have Sex With Men

2014 ◽  
Vol 1 (2) ◽  
Author(s):  
Travis H. Sanchez ◽  
Colleen F. Kelley ◽  
Eli Rosenberg ◽  
Nicole Luisi ◽  
Brandon O'Hara ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Self Report ◽  
Black Msm ◽  
Hiv Status ◽  
Hiv Viral Load ◽  
Hiv Test ◽  
Immunodeficiency Virus ◽  
Surveillance Report ◽  
Sex With Men

Background.  Lack of human immunodeficiency virus (HIV) infection awareness may be a driver of racial disparities in HIV infection among men who have sex with men (MSM). Lack of awareness is typically measured by comparing HIV test result to self-reported HIV status. This measure may be subject to reporting bias and alternatives are needed. Methods.  The InvolveMENt study examined HIV disparities between black and white MSM from Atlanta. Among HIV-positive participants who did not report knowing they were positive, we examined other measures of awareness: HIV viral load (VL) <1000 copies/mL (low VL), antiretroviral (ARV) drugs in blood, and previous HIV case surveillance report. Results.  Using self-report only, 32% (62 of 192) of black and 16% (7 of 45) of white MSM were not aware of their HIV infection (P = .03). Using self-report and low VL, 25% (48 of 192) black and 16% (7 of 45) white MSM lacked awareness (P = .18). Using self-report and ARVs, 26% (50 of 192) black and 16% (7 of 45) white MSM lacked awareness (P = .14). Using self-report and surveillance report, 15% (28 of 192) black and 13% (6 of 45) white MSM lacked awareness (P = .83). Conclusions.  Self-report only may overestimate true lack of awareness of HIV status for black MSM. If, as our data suggest, black MSM are not less likely to be aware of their HIV infection than are white MSM, then this factor is not a substantial driver of HIV disparity. Future HIV research that depends on accurate measurement of HIV status awareness should consider including additional laboratory and case surveillance data.

scholarly journals Gender variation in self-reported likelihood of HIV infection in comparison with HIV test results in rural and urban Nigeria

2011 ◽  
Vol 8 (1) ◽  
pp. 44 ◽  
Author(s):  
Adeniyi F Fagbamigbe ◽  
Joshua O Akinyemi ◽  
Babatunde O Adedokun ◽  
Elijah A Bamgboye
Keyword(s):  
Hiv Infection ◽  
Test Results ◽  
Gender Variation ◽  
Rural And Urban ◽  
Hiv Test

scholarly journals Gay's Self-Acceptance Process on HIV Positive Status

2021 ◽  
Vol 3 (1) ◽  
pp. 9-14
Author(s):  
Popy Apri Yanti ◽  
Dhesi Ari Astuti
Keyword(s):  
Critical Appraisal ◽  
The Self ◽  
Hiv Positive ◽  
Test Results ◽  
Hiv Status ◽  
Exclusion Criteria ◽  
Homosexual Orientation ◽  
Hiv Test ◽  
Self Acceptance ◽  
Over Time

Men with a homosexual orientation are more likely to experience depression than women who have a homosexual orientation. The purpose of this study was to conclude and examine the literatures related to the process of self-acceptance of Gays who were HIV positive. The method used was literature review by searching indexed articles from several database sources such as from PubMed, Proquest Disbursement of databases, scanning, and screening. In the search for the articles, 832 articles were identified. In addition, after filtering the titles, abstracts, and research methods, 103 articles were obtained to be taken and reviewed independently based on the inclusion and exclusion criteria. Then, a further article screening was carried out to find accurate and complete references regarding the self-acceptance process for ga  MSM who were HIV positive and obtained 10 articles for a critical appraisal. The author filtered the articles based on the critical appraisal results and obtained 4 articles for a final review based on the period of 2013 to 2018, and identified using an electronic database.The findings showed the process of self-acceptance of gay people who are HIV positive. The responses when they first found out that they were HIV positive mostly showed the same response, namely experiencing anxiety, shock, distrust and rejection of the HIV test results in the form stress and depression. Over time, the informants accepted themselves as HIV positive sufferers in a resigned and strong form. Most of them had not disclosed their HIV status, especially to their partners and families because they were afraid of rejection and stigma.

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