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Sarah E. Rutstein - One of the best experts on this subject based on the ideXlab platform.
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Challenges of HIV diagnosis and management in the context of pre‐exposure prophylaxis (PrEP), post‐exposure prophylaxis (PEP), test and start and Acute HIV Infection: a scoping review
Journal of the International AIDS Society, 2019Co-Authors: Tamara Elliott, Jintanat Ananworanich, Sarah E. Rutstein, Myron S. Cohen, Eduard J Sanders, Meg Doherty, Pragna Patel, Gus Cairns, Thumbi Ndung'u, Colin S BrownAbstract:Introduction Knowledge of HIV status relies on accurate HIV testing, and is the first step towards access to HIV treatment and prevention programmes. Globally, HIV-status unawareness represents a significant challenge for achieving zero new HIV Infections and deaths. In order to enhance knowledge of HIV status, the World Health Organisation (WHO) recommends a testing strategy that includes the use of HIV-specific antibody point-of-care tests (POCT). These POCTs do not detect Acute HIV Infection, the stage of disease when viral load is highest but HIV antibodies are undetectable. Complicating things further, in the presence of antiretroviral therapy (ART) for pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), other currently available testing technologies, such as viral load detection for diagnosis of Acute HIV Infection, may yield false-negative results. In this scoping review, we evaluate the evidence and discuss alternative HIV testing algorithms that may mitigate diagnostic dilemmas in the setting of increased utilization of ART for immediate treatment and prevention of HIV Infection. Discussion Missed Acute HIV Infection prevents people living with HIV (PLHIV) from accessing early treatment, increases likelihood of onward transmission, and allows for inappropriate initiation or continuation of PrEP, which may result in HIV drug resistance. While immediate ART is recommended for all PLHIV, studies have shown that starting ART in the setting of Acute HIV Infection may result in a delayed or complete absence of development of HIV-specific antibodies, posing a diagnostic challenge that is particularly pertinent to resource-limited, high HIV burden settings where HIV-antibody POCTs are standard of care. Similarly, ART used as PrEP or PEP may supress HIV RNA viral load, complicating current HIV testing algorithms in resource-wealthy settings where viral detection is included. As rollout of PrEP continues, HIV testing algorithms may need to be modified. Conclusions With increasing use of PrEP and ART in Acute Infection we anticipate diagnostic challenges using currently available HIV testing strategies. Research and surveillance are needed to determine the most appropriate assays and optimal testing algorithms that are accurate, affordable and sustainable.
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challenges of HIV diagnosis and management in the context of pre exposure prophylaxis prep post exposure prophylaxis pep test and start and Acute HIV Infection a scoping review
Journal of the International AIDS Society, 2019Co-Authors: Myron S. Cohen, Tamara Elliott, Eduard J Sanders, Meg Doherty, Thumbi Ndungu, Pragna Patel, Gus Cairns, Sarah E. RutsteinAbstract:Introduction Knowledge of HIV status relies on accurate HIV testing, and is the first step towards access to HIV treatment and prevention programmes. Globally, HIV-status unawareness represents a significant challenge for achieving zero new HIV Infections and deaths. In order to enhance knowledge of HIV status, the World Health Organisation (WHO) recommends a testing strategy that includes the use of HIV-specific antibody point-of-care tests (POCT). These POCTs do not detect Acute HIV Infection, the stage of disease when viral load is highest but HIV antibodies are undetectable. Complicating things further, in the presence of antiretroviral therapy (ART) for pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), other currently available testing technologies, such as viral load detection for diagnosis of Acute HIV Infection, may yield false-negative results. In this scoping review, we evaluate the evidence and discuss alternative HIV testing algorithms that may mitigate diagnostic dilemmas in the setting of increased utilization of ART for immediate treatment and prevention of HIV Infection. Discussion Missed Acute HIV Infection prevents people living with HIV (PLHIV) from accessing early treatment, increases likelihood of onward transmission, and allows for inappropriate initiation or continuation of PrEP, which may result in HIV drug resistance. While immediate ART is recommended for all PLHIV, studies have shown that starting ART in the setting of Acute HIV Infection may result in a delayed or complete absence of development of HIV-specific antibodies, posing a diagnostic challenge that is particularly pertinent to resource-limited, high HIV burden settings where HIV-antibody POCTs are standard of care. Similarly, ART used as PrEP or PEP may supress HIV RNA viral load, complicating current HIV testing algorithms in resource-wealthy settings where viral detection is included. As rollout of PrEP continues, HIV testing algorithms may need to be modified. Conclusions With increasing use of PrEP and ART in Acute Infection we anticipate diagnostic challenges using currently available HIV testing strategies. Research and surveillance are needed to determine the most appropriate assays and optimal testing algorithms that are accurate, affordable and sustainable.
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HIV status disclosure during Acute HIV Infection in Malawi.
PloS one, 2018Co-Authors: Sayaka Hino, Sam Phiri, Sarah E. Rutstein, Catherine A. Grodensky, Carol E. Golin, M. Kumi Smith, Lawrenson Christmas, William M. Miller, Cecilia Massa, Gift KamangaAbstract:Diagnosis of Acute HIV Infection (AHI) presents an opportunity to prevent HIV transmission during a highly infectious period. Disclosure is important during AHI as a means to facilitate safer sex practices and notify partners, particularly as those with AHI may be better able to identify the source of their Infection because of the recency of HIV acquisition. However, little is known about disclosure during AHI. We conducted 40 semi-structured interviews with Malawians diagnosed with AHI (24 men; 21 married). Most participants reported disclosing to a sexual partner within a month of diagnosis, and knew or had a strong suspicion about the source of their Infection. Participants often assumed their source had knowingly infected them, contributing to anger and feeling that disclosure is futile if the source already knew their HIV status. Assisted partner notification, individual and couples counseling, and couples HIV testing may facilitate disclosure during AHI. CLINICAL TRIAL REGISTRATION NUMBER NCT01450189.
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Detection of Acute HIV Infection: A Field Evaluation of the Determine® HIV-1/2 Ag/Ab Combo Test
The Journal of infectious diseases, 2011Co-Authors: Nora E. Rosenberg, Audrey Pettifor, Gift Kamanga, Sam Phiri, Dominic Nsona, Sarah E. Rutstein, Deborah D. Kamwendo, Irving F. Hoffman, Maria Keating, Lillian B. BrownAbstract:Point-of-care rapid tests for human immunodeficiency virus (HIV) antibody (Ab) detection have facilitated the scale-up of HIV counseling and testing throughout sub-Saharan Africa [1, 2]. The sensitivity of these tests approaches 100% for antibody detection [3, 4]. However, the tests cannot identify persons with Acute HIV Infection who have not yet developed HIV-specific antibodies [5–7]. Persons with Acute HIV Infection are often hyperinfectious because of high viral loads [8–12]. Integrating Acute HIV Infection detection into HIV testing algorithms would enable Acutely infected persons to learn their true HIV status, rather than being informed that they were HIV seronegative. Identifying these persons with Acute HIV Infection could enable intervention to prevent transmission and early treatment, potentially preserving immune function [13, 14]. Identification of Acute HIV Infection requires detection of HIV nucleic acids or p24 antigens. Available assays are laboratory based, resource intensive, and require follow-up. HIV RNA polymerase chain reaction (PCR), used for either individual or pooled samples, is the reference standard for detecting antibody-negative Acute HIV Infection, but it is expensive and difficult to implement in resource-poor settings. HIV p24 antigen (Ag) enzyme-linked immunosorbent assays (ELISAs) have good performance characteristics compared with HIV RNA PCR analysis, but they have been challenging to implement on a wide scale. Fourth-generation HIV ELISAs detect both antibodies and antigens [6, 15, 16] but do not distinguish between the two and require venipuncture, a laboratory, and patient follow-up, limiting routine use in most settings. A rapid point-of-care test capable of distinguishing established from Acute HIV Infection could improve the sensitivity of existing algorithms and enable provision of Acute HIV Infection results in real time [17]. The Determine® HIV-1/2 Ag/Ab Combo (Combo RT) is a point-of-care rapid test with separate indicators for HIV antibodies and p24 antigen. The Combo RT was designed to identify HIV earlier than other conventional rapid tests. The antibody portion is reported to be analogous to the Determine® HIV-1/2 antibody test, a widely used rapid test for HIV identification. The antigen component of the test is intended to expand the diagnostic spectrum to identify persons with circulating free p24 antigen, unbound to antibodies. During development, Combo RT antigen was assessed using stored serum from commercial seroconversion panels [18]. For primary HIV samples in the pre- or periseroconversion period, the reported sensitivity of the antigen portion of the Combo RT was 92.2%, compared with a fourth-generation HIV ELISA as the reference standard. Specificity of the antigen portion of the test was reported at 96.6%. The Combo RT is currently commercially available outside the United States. We conducted a field evaluation in Lilongwe, Malawi, to assess the accuracy of the antigen portion of Combo RT to detect persons with Acute HIV Infection. The Roche Monitor HIV RNA PCR assay was used to identify persons with Acute HIV Infection after routine HIV rapid test evaluation for established HIV Infection. We also performed an “ultrasensitive” heat-dissociated p24 antigen ELISA. Finally, in a subset of the study population, we assessed the antibody portion of Combo RT against a standard rapid test antibody algorithm.
Tamara Elliott - One of the best experts on this subject based on the ideXlab platform.
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Challenges of HIV diagnosis and management in the context of pre‐exposure prophylaxis (PrEP), post‐exposure prophylaxis (PEP), test and start and Acute HIV Infection: a scoping review
Journal of the International AIDS Society, 2019Co-Authors: Tamara Elliott, Jintanat Ananworanich, Sarah E. Rutstein, Myron S. Cohen, Eduard J Sanders, Meg Doherty, Pragna Patel, Gus Cairns, Thumbi Ndung'u, Colin S BrownAbstract:Introduction Knowledge of HIV status relies on accurate HIV testing, and is the first step towards access to HIV treatment and prevention programmes. Globally, HIV-status unawareness represents a significant challenge for achieving zero new HIV Infections and deaths. In order to enhance knowledge of HIV status, the World Health Organisation (WHO) recommends a testing strategy that includes the use of HIV-specific antibody point-of-care tests (POCT). These POCTs do not detect Acute HIV Infection, the stage of disease when viral load is highest but HIV antibodies are undetectable. Complicating things further, in the presence of antiretroviral therapy (ART) for pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), other currently available testing technologies, such as viral load detection for diagnosis of Acute HIV Infection, may yield false-negative results. In this scoping review, we evaluate the evidence and discuss alternative HIV testing algorithms that may mitigate diagnostic dilemmas in the setting of increased utilization of ART for immediate treatment and prevention of HIV Infection. Discussion Missed Acute HIV Infection prevents people living with HIV (PLHIV) from accessing early treatment, increases likelihood of onward transmission, and allows for inappropriate initiation or continuation of PrEP, which may result in HIV drug resistance. While immediate ART is recommended for all PLHIV, studies have shown that starting ART in the setting of Acute HIV Infection may result in a delayed or complete absence of development of HIV-specific antibodies, posing a diagnostic challenge that is particularly pertinent to resource-limited, high HIV burden settings where HIV-antibody POCTs are standard of care. Similarly, ART used as PrEP or PEP may supress HIV RNA viral load, complicating current HIV testing algorithms in resource-wealthy settings where viral detection is included. As rollout of PrEP continues, HIV testing algorithms may need to be modified. Conclusions With increasing use of PrEP and ART in Acute Infection we anticipate diagnostic challenges using currently available HIV testing strategies. Research and surveillance are needed to determine the most appropriate assays and optimal testing algorithms that are accurate, affordable and sustainable.
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challenges of HIV diagnosis and management in the context of pre exposure prophylaxis prep post exposure prophylaxis pep test and start and Acute HIV Infection a scoping review
Journal of the International AIDS Society, 2019Co-Authors: Myron S. Cohen, Tamara Elliott, Eduard J Sanders, Meg Doherty, Thumbi Ndungu, Pragna Patel, Gus Cairns, Sarah E. RutsteinAbstract:Introduction Knowledge of HIV status relies on accurate HIV testing, and is the first step towards access to HIV treatment and prevention programmes. Globally, HIV-status unawareness represents a significant challenge for achieving zero new HIV Infections and deaths. In order to enhance knowledge of HIV status, the World Health Organisation (WHO) recommends a testing strategy that includes the use of HIV-specific antibody point-of-care tests (POCT). These POCTs do not detect Acute HIV Infection, the stage of disease when viral load is highest but HIV antibodies are undetectable. Complicating things further, in the presence of antiretroviral therapy (ART) for pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), other currently available testing technologies, such as viral load detection for diagnosis of Acute HIV Infection, may yield false-negative results. In this scoping review, we evaluate the evidence and discuss alternative HIV testing algorithms that may mitigate diagnostic dilemmas in the setting of increased utilization of ART for immediate treatment and prevention of HIV Infection. Discussion Missed Acute HIV Infection prevents people living with HIV (PLHIV) from accessing early treatment, increases likelihood of onward transmission, and allows for inappropriate initiation or continuation of PrEP, which may result in HIV drug resistance. While immediate ART is recommended for all PLHIV, studies have shown that starting ART in the setting of Acute HIV Infection may result in a delayed or complete absence of development of HIV-specific antibodies, posing a diagnostic challenge that is particularly pertinent to resource-limited, high HIV burden settings where HIV-antibody POCTs are standard of care. Similarly, ART used as PrEP or PEP may supress HIV RNA viral load, complicating current HIV testing algorithms in resource-wealthy settings where viral detection is included. As rollout of PrEP continues, HIV testing algorithms may need to be modified. Conclusions With increasing use of PrEP and ART in Acute Infection we anticipate diagnostic challenges using currently available HIV testing strategies. Research and surveillance are needed to determine the most appropriate assays and optimal testing algorithms that are accurate, affordable and sustainable.
Myron S. Cohen - One of the best experts on this subject based on the ideXlab platform.
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Challenges of HIV diagnosis and management in the context of pre‐exposure prophylaxis (PrEP), post‐exposure prophylaxis (PEP), test and start and Acute HIV Infection: a scoping review
Journal of the International AIDS Society, 2019Co-Authors: Tamara Elliott, Jintanat Ananworanich, Sarah E. Rutstein, Myron S. Cohen, Eduard J Sanders, Meg Doherty, Pragna Patel, Gus Cairns, Thumbi Ndung'u, Colin S BrownAbstract:Introduction Knowledge of HIV status relies on accurate HIV testing, and is the first step towards access to HIV treatment and prevention programmes. Globally, HIV-status unawareness represents a significant challenge for achieving zero new HIV Infections and deaths. In order to enhance knowledge of HIV status, the World Health Organisation (WHO) recommends a testing strategy that includes the use of HIV-specific antibody point-of-care tests (POCT). These POCTs do not detect Acute HIV Infection, the stage of disease when viral load is highest but HIV antibodies are undetectable. Complicating things further, in the presence of antiretroviral therapy (ART) for pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), other currently available testing technologies, such as viral load detection for diagnosis of Acute HIV Infection, may yield false-negative results. In this scoping review, we evaluate the evidence and discuss alternative HIV testing algorithms that may mitigate diagnostic dilemmas in the setting of increased utilization of ART for immediate treatment and prevention of HIV Infection. Discussion Missed Acute HIV Infection prevents people living with HIV (PLHIV) from accessing early treatment, increases likelihood of onward transmission, and allows for inappropriate initiation or continuation of PrEP, which may result in HIV drug resistance. While immediate ART is recommended for all PLHIV, studies have shown that starting ART in the setting of Acute HIV Infection may result in a delayed or complete absence of development of HIV-specific antibodies, posing a diagnostic challenge that is particularly pertinent to resource-limited, high HIV burden settings where HIV-antibody POCTs are standard of care. Similarly, ART used as PrEP or PEP may supress HIV RNA viral load, complicating current HIV testing algorithms in resource-wealthy settings where viral detection is included. As rollout of PrEP continues, HIV testing algorithms may need to be modified. Conclusions With increasing use of PrEP and ART in Acute Infection we anticipate diagnostic challenges using currently available HIV testing strategies. Research and surveillance are needed to determine the most appropriate assays and optimal testing algorithms that are accurate, affordable and sustainable.
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challenges of HIV diagnosis and management in the context of pre exposure prophylaxis prep post exposure prophylaxis pep test and start and Acute HIV Infection a scoping review
Journal of the International AIDS Society, 2019Co-Authors: Myron S. Cohen, Tamara Elliott, Eduard J Sanders, Meg Doherty, Thumbi Ndungu, Pragna Patel, Gus Cairns, Sarah E. RutsteinAbstract:Introduction Knowledge of HIV status relies on accurate HIV testing, and is the first step towards access to HIV treatment and prevention programmes. Globally, HIV-status unawareness represents a significant challenge for achieving zero new HIV Infections and deaths. In order to enhance knowledge of HIV status, the World Health Organisation (WHO) recommends a testing strategy that includes the use of HIV-specific antibody point-of-care tests (POCT). These POCTs do not detect Acute HIV Infection, the stage of disease when viral load is highest but HIV antibodies are undetectable. Complicating things further, in the presence of antiretroviral therapy (ART) for pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), other currently available testing technologies, such as viral load detection for diagnosis of Acute HIV Infection, may yield false-negative results. In this scoping review, we evaluate the evidence and discuss alternative HIV testing algorithms that may mitigate diagnostic dilemmas in the setting of increased utilization of ART for immediate treatment and prevention of HIV Infection. Discussion Missed Acute HIV Infection prevents people living with HIV (PLHIV) from accessing early treatment, increases likelihood of onward transmission, and allows for inappropriate initiation or continuation of PrEP, which may result in HIV drug resistance. While immediate ART is recommended for all PLHIV, studies have shown that starting ART in the setting of Acute HIV Infection may result in a delayed or complete absence of development of HIV-specific antibodies, posing a diagnostic challenge that is particularly pertinent to resource-limited, high HIV burden settings where HIV-antibody POCTs are standard of care. Similarly, ART used as PrEP or PEP may supress HIV RNA viral load, complicating current HIV testing algorithms in resource-wealthy settings where viral detection is included. As rollout of PrEP continues, HIV testing algorithms may need to be modified. Conclusions With increasing use of PrEP and ART in Acute Infection we anticipate diagnostic challenges using currently available HIV testing strategies. Research and surveillance are needed to determine the most appropriate assays and optimal testing algorithms that are accurate, affordable and sustainable.
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Acute HIV Infection among pregnant women in Malawi.
Diagnostic microbiology and infectious disease, 2010Co-Authors: Victor Mwapasa, Susan A. Fiscus, David Murdoch, Jesse J. Kwiek, Steven R. Meshnick, Myron S. CohenAbstract:There are limited data on Acute HIV Infection (AHI) prevalence during pregnancy. Malawian pregnant women admitted in the third trimester and meeting eligibility criteria underwent dual HIV rapid antibody testing. AHI prevalence was retrospectively detected through HIV RNA pooling of seronegative plasma. Among 3,825 pregnant women screened, dual HIV rapid testing indicated that 30.2% were HIV positive, 69.7% were HIV negative, and 0.1% were indeterminate. Sensitivity and specificity of dual rapid testing was 99.0% and 98.7%, respectively. Of 2,666 seronegative specimens, 2,327 had samples available for HIV RNA pooling; 5 women (0.21%) (95% confidence interval, 0.03-0.40%) had AHI with a median peripartum viral load of 1,324,766 copies/mL. Pregnant women are at risk for AHI, warranting counseling of all women and their sexual partners about incident HIV during pregnancy. Dual HIV rapid tests have high sensitivity and specificity. HIV testing should be repeated in the third trimester and/or at delivery.
Eduard J Sanders - One of the best experts on this subject based on the ideXlab platform.
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Challenges of HIV diagnosis and management in the context of pre‐exposure prophylaxis (PrEP), post‐exposure prophylaxis (PEP), test and start and Acute HIV Infection: a scoping review
Journal of the International AIDS Society, 2019Co-Authors: Tamara Elliott, Jintanat Ananworanich, Sarah E. Rutstein, Myron S. Cohen, Eduard J Sanders, Meg Doherty, Pragna Patel, Gus Cairns, Thumbi Ndung'u, Colin S BrownAbstract:Introduction Knowledge of HIV status relies on accurate HIV testing, and is the first step towards access to HIV treatment and prevention programmes. Globally, HIV-status unawareness represents a significant challenge for achieving zero new HIV Infections and deaths. In order to enhance knowledge of HIV status, the World Health Organisation (WHO) recommends a testing strategy that includes the use of HIV-specific antibody point-of-care tests (POCT). These POCTs do not detect Acute HIV Infection, the stage of disease when viral load is highest but HIV antibodies are undetectable. Complicating things further, in the presence of antiretroviral therapy (ART) for pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), other currently available testing technologies, such as viral load detection for diagnosis of Acute HIV Infection, may yield false-negative results. In this scoping review, we evaluate the evidence and discuss alternative HIV testing algorithms that may mitigate diagnostic dilemmas in the setting of increased utilization of ART for immediate treatment and prevention of HIV Infection. Discussion Missed Acute HIV Infection prevents people living with HIV (PLHIV) from accessing early treatment, increases likelihood of onward transmission, and allows for inappropriate initiation or continuation of PrEP, which may result in HIV drug resistance. While immediate ART is recommended for all PLHIV, studies have shown that starting ART in the setting of Acute HIV Infection may result in a delayed or complete absence of development of HIV-specific antibodies, posing a diagnostic challenge that is particularly pertinent to resource-limited, high HIV burden settings where HIV-antibody POCTs are standard of care. Similarly, ART used as PrEP or PEP may supress HIV RNA viral load, complicating current HIV testing algorithms in resource-wealthy settings where viral detection is included. As rollout of PrEP continues, HIV testing algorithms may need to be modified. Conclusions With increasing use of PrEP and ART in Acute Infection we anticipate diagnostic challenges using currently available HIV testing strategies. Research and surveillance are needed to determine the most appropriate assays and optimal testing algorithms that are accurate, affordable and sustainable.
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challenges of HIV diagnosis and management in the context of pre exposure prophylaxis prep post exposure prophylaxis pep test and start and Acute HIV Infection a scoping review
Journal of the International AIDS Society, 2019Co-Authors: Myron S. Cohen, Tamara Elliott, Eduard J Sanders, Meg Doherty, Thumbi Ndungu, Pragna Patel, Gus Cairns, Sarah E. RutsteinAbstract:Introduction Knowledge of HIV status relies on accurate HIV testing, and is the first step towards access to HIV treatment and prevention programmes. Globally, HIV-status unawareness represents a significant challenge for achieving zero new HIV Infections and deaths. In order to enhance knowledge of HIV status, the World Health Organisation (WHO) recommends a testing strategy that includes the use of HIV-specific antibody point-of-care tests (POCT). These POCTs do not detect Acute HIV Infection, the stage of disease when viral load is highest but HIV antibodies are undetectable. Complicating things further, in the presence of antiretroviral therapy (ART) for pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), other currently available testing technologies, such as viral load detection for diagnosis of Acute HIV Infection, may yield false-negative results. In this scoping review, we evaluate the evidence and discuss alternative HIV testing algorithms that may mitigate diagnostic dilemmas in the setting of increased utilization of ART for immediate treatment and prevention of HIV Infection. Discussion Missed Acute HIV Infection prevents people living with HIV (PLHIV) from accessing early treatment, increases likelihood of onward transmission, and allows for inappropriate initiation or continuation of PrEP, which may result in HIV drug resistance. While immediate ART is recommended for all PLHIV, studies have shown that starting ART in the setting of Acute HIV Infection may result in a delayed or complete absence of development of HIV-specific antibodies, posing a diagnostic challenge that is particularly pertinent to resource-limited, high HIV burden settings where HIV-antibody POCTs are standard of care. Similarly, ART used as PrEP or PEP may supress HIV RNA viral load, complicating current HIV testing algorithms in resource-wealthy settings where viral detection is included. As rollout of PrEP continues, HIV testing algorithms may need to be modified. Conclusions With increasing use of PrEP and ART in Acute Infection we anticipate diagnostic challenges using currently available HIV testing strategies. Research and surveillance are needed to determine the most appropriate assays and optimal testing algorithms that are accurate, affordable and sustainable.
Jintanat Ananworanich - One of the best experts on this subject based on the ideXlab platform.
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Challenges of HIV diagnosis and management in the context of pre‐exposure prophylaxis (PrEP), post‐exposure prophylaxis (PEP), test and start and Acute HIV Infection: a scoping review
Journal of the International AIDS Society, 2019Co-Authors: Tamara Elliott, Jintanat Ananworanich, Sarah E. Rutstein, Myron S. Cohen, Eduard J Sanders, Meg Doherty, Pragna Patel, Gus Cairns, Thumbi Ndung'u, Colin S BrownAbstract:Introduction Knowledge of HIV status relies on accurate HIV testing, and is the first step towards access to HIV treatment and prevention programmes. Globally, HIV-status unawareness represents a significant challenge for achieving zero new HIV Infections and deaths. In order to enhance knowledge of HIV status, the World Health Organisation (WHO) recommends a testing strategy that includes the use of HIV-specific antibody point-of-care tests (POCT). These POCTs do not detect Acute HIV Infection, the stage of disease when viral load is highest but HIV antibodies are undetectable. Complicating things further, in the presence of antiretroviral therapy (ART) for pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), other currently available testing technologies, such as viral load detection for diagnosis of Acute HIV Infection, may yield false-negative results. In this scoping review, we evaluate the evidence and discuss alternative HIV testing algorithms that may mitigate diagnostic dilemmas in the setting of increased utilization of ART for immediate treatment and prevention of HIV Infection. Discussion Missed Acute HIV Infection prevents people living with HIV (PLHIV) from accessing early treatment, increases likelihood of onward transmission, and allows for inappropriate initiation or continuation of PrEP, which may result in HIV drug resistance. While immediate ART is recommended for all PLHIV, studies have shown that starting ART in the setting of Acute HIV Infection may result in a delayed or complete absence of development of HIV-specific antibodies, posing a diagnostic challenge that is particularly pertinent to resource-limited, high HIV burden settings where HIV-antibody POCTs are standard of care. Similarly, ART used as PrEP or PEP may supress HIV RNA viral load, complicating current HIV testing algorithms in resource-wealthy settings where viral detection is included. As rollout of PrEP continues, HIV testing algorithms may need to be modified. Conclusions With increasing use of PrEP and ART in Acute Infection we anticipate diagnostic challenges using currently available HIV testing strategies. Research and surveillance are needed to determine the most appropriate assays and optimal testing algorithms that are accurate, affordable and sustainable.
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Depression and Anxiety are Common in Acute HIV Infection and Associate with Plasma Immune Activation
AIDS and behavior, 2017Co-Authors: Joanna Hellmuth, Jintanat Ananworanich, Victor Valcour, Napapon Sailasuta, Duanghathai Suttichom, Isabel E. Allen, Donn J. Colby, Serena Spudich, Peeriya Prueksakaew, Linda L JagodzinskiAbstract:This observational study of 123 Thai participants sought to determine the rate and severity of affective symptoms during Acute HIV Infection (AHI) and possible associations to disease mechanisms. At diagnosis, just prior to starting combination antiretroviral therapy (cART), AHI participants completed assessments of depression and anxiety symptoms that were repeated at 4, 12, and 24 weeks. Blood markers of HIV Infection and immune activation were measured at study entry, with optional cerebrospinal fluid measures. A high frequency of participants reported symptoms that exceeded published thresholds supportive of depression (55.0%) and anxiety (65.8%) at diagnosis, with significant reductions after starting cART. Meeting a threshold for clinically relevant depressive symptoms at study entry was associated with higher baseline plasma HIV RNA (5.98 vs. 5.50, t = 2.46, p = 0.015), lower CD4 counts (328 vs. 436 cells/mm3, t = 3.46, p = 0.001), and higher plasma neopterin, a marker of macrophage activation (2694 vs. 1730 pg/mL, Mann–Whitney U = 152.5, p = 0.011). Controlling for plasma HIV RNA and CD4 count, higher baseline plasma neopterin correlated with worse initial depression and anxiety scores. Depression and anxiety symptoms are frequent in Acute HIV Infection, associate with plasma immune activation, and can improve concurrent with cART.
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Neurologic signs and symptoms frequently manifest in Acute HIV Infection
Neurology, 2016Co-Authors: Joanna Hellmuth, Jintanat Ananworanich, James L. K. Fletcher, Eugene Kroon, Victor Valcour, Sukalaya Lerdlum, Jintana Intasan, Jared Narvid, Mantana Pothisri, Isabel E. AllenAbstract:Objective: To determine the incidence, timing, and severity of neurologic findings in Acute HIV Infection (pre–antibody seroconversion), as well as persistence with combination antiretroviral therapy (cART). Methods: Participants identified with Acute HIV were enrolled, underwent structured neurologic evaluations, immediately initiated cART, and were followed with neurologic evaluations at 4 and 12 weeks. Concurrent brain MRIs and both viral and inflammatory markers in plasma and CSF were obtained. Results: Median estimated HIV Infection duration was 19 days (range 3–56) at study entry for the 139 participants evaluated. Seventy-three participants (53%) experienced one or more neurologic findings in the 12 weeks after diagnosis, with one developing a fulminant neurologic manifestation (Guillain-Barre syndrome). A total of 245 neurologic findings were noted, reflecting cognitive symptoms (33%), motor findings (34%), and neuropathy (11%). Nearly half of the neurologic findings (n = 121, 49%) occurred at diagnosis, prior to cART initiation, and most of these (n = 110, 90%) remitted concurrent with 1 month on treatment. Only 9% of neurologic findings (n = 22) persisted at 24 weeks on cART. Nearly all neurologic findings (n = 236, 96%) were categorized as mild in severity. No structural neuroimaging abnormalities were observed. Participants with neurologic findings had a higher mean plasma log 10 HIV RNA at diagnosis compared to those without neurologic findings (5.9 vs 5.4; p = 0.006). Conclusions: Acute HIV Infection is commonly associated with mild neurologic findings that largely remit while on treatment, and may be mediated by direct viral factors. Severe neurologic manifestations are infrequent in treated Acute HIV.
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Lessons from Acute HIV Infection.
Current opinion in HIV and AIDS, 2016Co-Authors: Merlin L. Robb, Jintanat AnanworanichAbstract:Purpose of reviewUnderstanding the characteristics of transmission during Acute HIV Infection (AHI) may inform targets for vaccine-induced immune interdiction. Individuals treated in AHI with a small HIV reservoir size may be ideal candidates for therapeutic HIV vaccines aiming for HIV remission (i.
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Broadly neutralizing antibody and the HIV reservoir in Acute HIV Infection: a strategy toward HIV remission?
Current opinion in HIV and AIDS, 2015Co-Authors: Jintanat Ananworanich, Brian Mcsteen, Merlin L. RobbAbstract:Purpose of review Infection of long-lived CD4 T cells is a major obstacle to HIV remission, and antiretroviral therapy (ART) instituted during Acute HIV Infection restricts HIV reservoir establishment. Broadly neutralizing antibodies (bNAbs) may be employed in conjunction with early ART as strategies toward HIV remission. Recent findings Proof-of-concept studies in vitro and in animal models demonstrated bNAbs' ability to block viral entry into cells, suppress viremia and reduce cell-associated viral DNA. Combination bNAbs were more effective than single bNAb in suppressing viremia. When bNAb was used with ART with or without combination latency reversing agents, it prevented viral rebound after ART interruption in at least half of the animals. In one study, macaques with low baseline viral load achieved viral remission even after the blood bNAb titer was no longer detected. Summary The Acute HIV Infection period represents a unique opportunity to explore the use of bNAbs with ART to limit the reservoir seeding that may enhance the chance of HIV remission. This article discusses the effects of early ART and bNAbs on HIV reservoirs and proposes research strategies in Acute HIV Infection aiming at HIV reservoir reduction and HIV remission.
