scholarly journals A Novel HIV-1 RNA Testing Intervention to Detect Acute and Prevalent HIV Infection in Young Adults and Reduce HIV Transmission in Kenya: Protocol for a Randomized Controlled Trial

10.2196/16198 ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. e16198
Author(s):  
Susan M Graham ◽  
Clara Agutu ◽  
Elise van der Elst ◽  
Amin S Hassan ◽  
Evanson Gichuru ◽  
...  
Keyword(s):  
Young Adults ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Hiv Transmission ◽  
Partner Notification ◽  
Newly Diagnosed ◽  
Intervention Period ◽  
Acute Hiv Infection ◽  
Art Initiation ◽  
Acute Hiv

Background Detection and management of acute HIV infection (AHI) is a clinical and public health priority, and HIV infections diagnosed among young adults aged 18 to 39 years are usually recent. Young adults with recent HIV acquisition frequently seek care for symptoms and could potentially be diagnosed through the health care system. Early recognition of HIV infection provides considerable individual and public health benefits, including linkage to treatment as prevention, access to risk reduction counseling and treatment, and notification of partners in need of HIV testing. Objective The Tambua Mapema Plus study aims to (1) test 1500 young adults (aged 18-39 years) identified by an AHI screening algorithm for acute and prevalent (ie, seropositive) HIV, linking all newly diagnosed HIV-infected patients to care and offering immediate treatment; (2) offer assisted HIV partner notification services to all patients with HIV, testing partners for acute and prevalent HIV infection and identifying local sexual networks; and (3) model the potential impact of these two interventions on the Kenyan HIV epidemic, estimating incremental costs per HIV infection averted, death averted, and disability-adjusted life year averted using data on study outcomes. Methods A modified stepped-wedge design is evaluating the yield of this HIV testing intervention at 4 public and 2 private health facilities in coastal Kenya before and after intervention delivery. The intervention uses point-of-care HIV-1 RNA testing combined with standard rapid antibody tests to diagnose AHI and prevalent HIV among young adults presenting for care, employs HIV partner notification services to identify linked acute and prevalent infections, and follows all newly diagnosed patients and their partners for 12 months to ascertain clinical outcomes, including linkage to care, antiretroviral therapy (ART) initiation and virologic suppression in HIV-infected patients, and pre-exposure prophylaxis uptake in uninfected individuals in discordant partnerships. Results Enrollment started in December 2017. As of April 2020, 1374 participants have been enrolled in the observation period and 1500 participants have been enrolled in the intervention period, with 13 new diagnoses (0.95%) in the observation period and 37 new diagnoses (2.47%), including 2 AHI diagnoses, in the intervention period. Analysis is ongoing and will include adjusted comparisons of the odds of the following outcomes in the observation and intervention periods: being tested for HIV infection, newly diagnosed with prevalent or acute HIV infection, linked to care, and starting ART by week 6 following HIV diagnosis. Participants newly diagnosed with acute or prevalent HIV infection in the intervention period are being followed for outcomes, including viral suppression by month 6 and month 12 following ART initiation and partner testing outcomes. Conclusions The Tambua Mapema Plus study will provide foundational data on the potential of this novel combination HIV prevention intervention to reduce ongoing HIV transmission in Kenya and other high-prevalence African settings. Trial Registration ClinicalTrials.gov NCT03508908; https://clinicaltrials.gov/ct2/show/NCT03508908 International Registered Report Identifier (IRRID) DERR1-10.2196/16198

scholarly journals A Novel HIV-1 RNA Testing Intervention to Detect Acute and Prevalent HIV Infection in Young Adults and Reduce HIV Transmission in Kenya: Protocol for a Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Susan M Graham ◽  
Clara Agutu ◽  
Elise van der Elst ◽  
Amin S Hassan ◽  
Evanson Gichuru ◽  
...  
Keyword(s):  
Young Adults ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Hiv Transmission ◽  
Partner Notification ◽  
Newly Diagnosed ◽  
Intervention Period ◽  
Acute Hiv Infection ◽  
Art Initiation ◽  
Acute Hiv

BACKGROUND Detection and management of acute HIV infection (AHI) is a clinical and public health priority, and HIV infections diagnosed among young adults aged 18 to 39 years are usually recent. Young adults with recent HIV acquisition frequently seek care for symptoms and could potentially be diagnosed through the health care system. Early recognition of HIV infection provides considerable individual and public health benefits, including linkage to treatment as prevention, access to risk reduction counseling and treatment, and notification of partners in need of HIV testing. OBJECTIVE The Tambua Mapema Plus study aims to (1) test 1500 young adults (aged 18-39 years) identified by an AHI screening algorithm for acute and prevalent (ie, seropositive) HIV, linking all newly diagnosed HIV-infected patients to care and offering immediate treatment; (2) offer assisted HIV partner notification services to all patients with HIV, testing partners for acute and prevalent HIV infection and identifying local sexual networks; and (3) model the potential impact of these two interventions on the Kenyan HIV epidemic, estimating incremental costs per HIV infection averted, death averted, and disability-adjusted life year averted using data on study outcomes. METHODS A modified stepped-wedge design is evaluating the yield of this HIV testing intervention at 4 public and 2 private health facilities in coastal Kenya before and after intervention delivery. The intervention uses point-of-care HIV-1 RNA testing combined with standard rapid antibody tests to diagnose AHI and prevalent HIV among young adults presenting for care, employs HIV partner notification services to identify linked acute and prevalent infections, and follows all newly diagnosed patients and their partners for 12 months to ascertain clinical outcomes, including linkage to care, antiretroviral therapy (ART) initiation and virologic suppression in HIV-infected patients, and pre-exposure prophylaxis uptake in uninfected individuals in discordant partnerships. RESULTS Enrollment started in December 2017. As of April 2020, 1374 participants have been enrolled in the observation period and 1500 participants have been enrolled in the intervention period, with 13 new diagnoses (0.95%) in the observation period and 37 new diagnoses (2.47%), including 2 AHI diagnoses, in the intervention period. Analysis is ongoing and will include adjusted comparisons of the odds of the following outcomes in the observation and intervention periods: being tested for HIV infection, newly diagnosed with prevalent or acute HIV infection, linked to care, and starting ART by week 6 following HIV diagnosis. Participants newly diagnosed with acute or prevalent HIV infection in the intervention period are being followed for outcomes, including viral suppression by month 6 and month 12 following ART initiation and partner testing outcomes. CONCLUSIONS The Tambua Mapema Plus study will provide foundational data on the potential of this novel combination HIV prevention intervention to reduce ongoing HIV transmission in Kenya and other high-prevalence African settings. CLINICALTRIAL ClinicalTrials.gov NCT03508908; https://clinicaltrials.gov/ct2/show/NCT03508908 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/16198

scholarly journals Abundant HIV-infected cells in blood and tissues are rapidly cleared upon ART initiation during acute HIV infection

2020 ◽  
Vol 12 (533) ◽  
pp. eaav3491 ◽  
Author(s):  
Louise Leyre ◽  
Eugène Kroon ◽  
Claire Vandergeeten ◽  
Carlo Sacdalan ◽  
Donn J. Colby ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Stage Iv ◽  
T Cell Subsets ◽  
Viral Reservoir ◽  
Lymphoid Tissues ◽  
Acute Hiv Infection ◽  
Tissue Samples ◽  
Art Initiation ◽  
Acute Hiv ◽  
Infected Cells

The timing and location of the establishment of the viral reservoir during acute HIV infection remain unclear. Using longitudinal blood and tissue samples obtained from HIV-infected individuals at the earliest stage of infection, we demonstrate that frequencies of infected cells reach maximal values in gut-associated lymphoid tissue and lymph nodes as early as Fiebig stage II, before seroconversion. Both tissues displayed higher frequencies of infected cells than blood until Fiebig stage III, after which infected cells were equally distributed in all compartments examined. Initiation of antiretroviral therapy (ART) at Fiebig stages I to III led to a profound decrease in the frequency of infected cells to nearly undetectable level in all compartments. The rare infected cells that persisted were preferentially found in the lymphoid tissues. Initiation of ART at later stages (Fiebig stages IV/V and chronic infection) induced only a modest reduction in the frequency of infected cells. Quantification of HIV DNA in memory CD4+ T cell subsets confirmed the unstable nature of most of the infected cells at Fiebig stages I to III and the emergence of persistently infected cells during the transition to Fiebig stage IV. Our results indicate that although a large pool of cells is infected during acute HIV infection, most of these early targets are rapidly cleared upon ART initiation. Therefore, infected cells present after peak viremia have a greater ability to persist.

scholarly journals Acute HIV infection: Improved algorithms for HIV testing

2015 ◽  
Vol 63 ◽  
pp. 51-52 ◽  
Author(s):  
Valeria Ghisetti ◽  
Andrea Calcagno ◽  
Elisa Burdino ◽  
Giancarlo Orofino ◽  
Stefano Bonora
Keyword(s):  
Hiv Infection ◽  
Hiv Testing ◽  
Acute Hiv Infection ◽  
Acute Hiv

scholarly journals Knowledge and Awareness of Acute Human Immunodeficiency Virus Infection Among Mobile App-Using Men Who Have Sex With Men: A Missed Public Health Opportunity

2015 ◽  
Vol 2 (1) ◽  
Author(s):  
Aaron J. Siegler ◽  
Travis Sanchez ◽  
R. Craig Sineath ◽  
Jeremy Grey ◽  
Erin Kahle ◽  
...  
Keyword(s):  
Public Health ◽  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Online Survey ◽  
Mobile App ◽  
Acute Hiv Infection ◽  
Immunodeficiency Virus ◽  
Acute Hiv ◽  
Sex With Men

Abstract In a national online survey, we assessed awareness and knowledge of acute human immunodeficiency virus (HIV) infection manifestation among 1748 men who have sex with men (MSM). Only 39% of respondents were aware that acute HIV infection may be accompanied by symptoms. Education and increased access to acute HIV testing may facilitate MSM to appropriately seek acute HIV testing.

scholarly journals Leveraging a Rapid, Round-the-Clock HIV Testing System to Screen for Acute HIV Infection in a Large Urban Public Medical Center

2013 ◽  
Vol 62 (2) ◽  
pp. e30-e38 ◽  
Author(s):  
Katerina A. Christopoulos ◽  
Nicola M. Zetola ◽  
Jeffrey D. Klausner ◽  
Barbara Haller ◽  
Brian Louie ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Hiv Testing ◽  
Medical Center ◽  
Testing System ◽  
Acute Hiv Infection ◽  
Acute Hiv

scholarly journals Understanding of Perceived Infectiousness and Its Influence on Sexual Behavior Among Individuals With Acute HIV Infection in Lilongwe, Malawi (HPTN 062)

2020 ◽  
Vol 32 (3) ◽  
pp. 260-270
Author(s):  
Tiarney D. Ritchwood ◽  
Cecilia Massa ◽  
Gift Kamanga ◽  
Audrey Pettifor ◽  
Irving Hoffman ◽  
...  
Keyword(s):  
Sexual Behavior ◽  
Viral Load ◽  
Mixed Methods ◽  
Hiv Infection ◽  
Hiv Transmission ◽  
Unprotected Sex ◽  
Acute Hiv Infection ◽  
Acute Hiv ◽  
Key Aspects ◽  
To Receive

We implemented HPTN 062, an acceptability and feasibility study of a motivational-interviewing (MI) intervention to reduce HIV transmission among individuals with acute HIV infection (AHI) in Lilongwe, Malawi. Participants were randomly assigned to receive either brief education or the MI intervention over 24 weeks; all participants received the same messages about AHI. We used mixed methods to assess participants' understanding of the association between AHI and viral load, and its connection to sexual behavior at 8 weeks. While most participants understood key aspects of AHI, MI-intervention participants gave substantially more detailed descriptions of their understanding. Nearly all participants, regardless of study arm, understood that they were highly infectious and would be very likely to transmit HIV after unprotected sex during AHI. Our findings suggest that messages about AHI delivered during the period of AHI are likely beneficial for ensuring that those with AHI understand their level of infectiousness and its association with forward transmission.

Case 36

2020 ◽  
pp. 247-254
Author(s):  
Andrew Woodhouse
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Immune Function ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Newly Diagnosed ◽  
Acute Hiv Infection ◽  
Immunodeficiency Virus ◽  
Acute Hiv

Human immunodeficiency virus (HIV) infection is a worldwide infection and new cases continue to occur. Recognizing features of acute HIV infection and also underlying conditions that might reflect longer-standing infection are key to diagnosis. This allows treatment to be started which can maintain or improve health and prevent further deterioration of immune function. Treatment is indicated for the majority of newly diagnosed cases irrespective of immune function status. Current treatment strategies are so effective and tolerable now compared to early antiretroviral regimens that HIV has become a long-term manageable condition for the majority of newly diagnosed people who are able to access antiretroviral therapy.

scholarly journals Impact of Acute HIV Infection and Early Antiretroviral Therapy on the Human Gut Microbiome

2019 ◽  
Vol 7 (12) ◽  
Author(s):  
Ornella Sortino ◽  
Nittaya Phanuphak ◽  
Alexandra Schuetz ◽  
Alexandra M Ortiz ◽  
Nitiya Chomchey ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Inflammatory Markers ◽  
Acute Infection ◽  
Fecal Microbiota ◽  
Acute Hiv Infection ◽  
Gut Dysbiosis ◽  
Art Initiation ◽  
Rdna Sequencing ◽  
Acute Hiv

Abstract Background Intestinal microbial dysbiosis is evident in chronic HIV-infected individuals and may underlie inflammation that persists even during antiretroviral therapy (ART). It remains unclear, however, how early after HIV infection gut dysbiosis emerges and how it is affected by early ART. Methods Fecal microbiota were studied by 16s rDNA sequencing in 52 Thai men who have sex with men (MSM), at diagnosis of acute HIV infection (AHI), Fiebig Stages 1–5 (F1-5), and after 6 months of ART initiation, and in 7 Thai MSM HIV-uninfected controls. Dysbiotic bacterial taxa were associated with relevant inflammatory markers. Results Fecal microbiota profiling of AHI pre-ART vs HIV-uninfected controls showed a mild dysbiosis. Transition from F1-3 of acute infection was characterized by enrichment in pro-inflammatory bacteria. Lower proportions of Bacteroidetes and higher frequencies of Proteobacteria and Fusobacteria members were observed post-ART compared with pre-ART. Fusobacteria members were positively correlated with levels of soluble CD14 in AHI post-ART. Conclusions Evidence of gut dysbiosis was observed during early acute HIV infection and was partially restored upon early ART initiation. The association of dysbiotic bacterial taxa with inflammatory markers suggests that a potential relationship between altered gut microbiota and systemic inflammation may also be established during AHI.

scholarly journals Implementing Rapid Initiation of Antiretroviral Therapy for Acute HIV Infection Within a Routine Testing and Linkage to Care Program in Chicago

2020 ◽  
Vol 19 ◽  
pp. 232595822093975
Author(s):  
Moira McNulty ◽  
Jessica Schmitt ◽  
Eleanor Friedman ◽  
Bijou Hunt ◽  
Audra Tobin ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Viral Suppression ◽  
Linkage To Care ◽  
Care Program ◽  
Acute Hiv Infection ◽  
Screening Programs ◽  
Acute Hiv ◽  
Therapy Clients

Growing evidence suggests that rapid initiation of antiretroviral therapy for HIV improves care continuum outcomes. We evaluated process and clinical outcomes for rapid initiation in acute HIV infection within a multisite health care–based HIV testing and linkage to care program in Chicago. Through retrospective analysis of HIV testing data (2016-2017), we assessed linkage to care, initiation of antiretroviral therapy, and viral suppression. Of 334 new HIV diagnoses, 33 (9.9%) individuals had acute HIV infection. Median time to linkage was 11 (interquartile range [IQR]: 5-19.5) days, with 15 days (IQR 5-27) to initiation of antiretroviral therapy. Clients achieved viral suppression at a median of 131 (IQR: 54-188) days. Of all, 69.7% were retained in care, all of whom were virally suppressed. Sites required few additional resources to incorporate rapid initiation into existing processes. Integration of rapid initiation of antiretroviral therapy into existing HIV screening programs is a promising strategy for scaling up this important intervention.

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