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Predicting, Diagnosing, and Treating Acute and Early HIV Infection in a Public Sector Facility in Eswatini.

Authors :
Kerschberger B
Aung A
Mpala Q
Ntshalintshali N
Mamba C
Schomaker M
Tombo ML
Maphalala G
Sibandze D
Dube L
Kashangura R
Mthethwa-Hleza S
Telnov A
Tour R
Gonzalez A
Calmy A
Ciglenecki I
Source :
Journal of acquired immune deficiency syndromes (1999) [J Acquir Immune Defic Syndr] 2021 Dec 15; Vol. 88 (5), pp. 506-517.
Publication Year :
2021

Abstract

Background: The lack of acute and early HIV infection (AEHI) diagnosis and care contributes to high HIV incidence in resource-limited settings. We aimed to assess the yield of AEHI, predict and diagnose AEHI, and describe AEHI care outcomes in a public sector setting in Eswatini.<br />Setting: This study was conducted in Nhlangano outpatient department from March 2019 to March 2020.<br />Methods: Adults at risk of AEHI underwent diagnostic testing for AEHI with the quantitative Xpert HIV-1 viral load (VL) assay. AEHI was defined as the detection of HIV-1 VL on Xpert and either an HIV-seronegative or HIV-serodiscordant third-generation antibody-based rapid diagnostic test (RDT) result. First, the cross-sectional analysis obtained the yield of AEHI and established a predictor risk score for the prediction of AEHI using Lasso logistic regression. Second, diagnostic accuracy statistics described the ability of the fourth-generation antibody/p24 antigen-based Alere HIV-Combo RDT to diagnose AEHI (vs Xpert VL testing). Third, we described acute HIV infection care outcomes of AEHI-positive patients using survival analysis.<br />Results: Of 795 HIV-seronegative/HIV-serodiscordant outpatients recruited, 30 (3.8%, 95% confidence interval: 2.6% to 5.3%) had AEHI. The predictor risk score contained several factors (HIV-serodiscordant RDT, women, feeling at risk of HIV, swollen glands, and fatigue) and had sensitivity and specificity of 83.3% and 65.8%, respectively, to predict AEHI. The HIV-Combo RDT had sensitivity and specificity of 86.2% and 99.9%, respectively, to diagnose AEHI. Of 30 AEHI-positive patients, the 1-month cumulative treatment initiation was 74% (95% confidence interval: 57% to 88%), and the 3-month viral suppression (<1000 copies/mL) was 87% (67% to 98%).<br />Conclusion: AEHI diagnosis and care seem possible in resource-limited settings.<br />Competing Interests: The authors have no conflicts of interest to disclose.<br /> (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

Details

Language :
English
ISSN :
1944-7884
Volume :
88
Issue :
5
Database :
MEDLINE
Journal :
Journal of acquired immune deficiency syndromes (1999)
Publication Type :
Academic Journal
Accession number :
34483294
Full Text :
https://doi.org/10.1097/QAI.0000000000002794