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

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...

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Bibliographic Details
Published in:Journal of the International AIDS Society Vol. 22; no. 12; pp. e25419 - n/a
Main Authors: Elliott, Tamara, Sanders, Eduard J, Doherty, Meg, Ndung'u, Thumbi, Cohen, Myron, Patel, Pragna, Cairns, Gus, Rutstein, Sarah E, Ananworanich, Jintanat, Brown, Colin, Fidler, Sarah
Format: Journal Article
Language:English
Published: Switzerland International AIDS Society 01.12.2019
John Wiley & Sons, Inc
John Wiley and Sons Inc
Subjects:
Acquired immune deficiency syndrome
Acute HIV infection
AIDS
AIDS (Disease)
AIDS research
AIDS treatment
Algorithms
Anti-HIV Agents - administration & dosage
Anti-HIV Agents - therapeutic use
Antigens
Antiretroviral agents
Antiretroviral drugs
Antiviral agents
Care and treatment
Development and progression
Diagnosis
Disease prevention
Dosage and administration
Drug resistance
Drug therapy
Emtricitabine
FDA approval
Health aspects
Highly active antiretroviral therapy
HIV
HIV antibodies
HIV infection
HIV infections
HIV Infections - drug therapy
HIV Infections - prevention & control
HIV testing algorithms
HIV tests
Human immunodeficiency virus
Humans
immediate antiretroviral therapy
Immunoassay
Immunoglobulins
indeterminate HIV test
Infections
Laboratories
Male
Management
Medical tests
Medicine, Preventive
Patients
Post-Exposure Prophylaxis - methods
post‐exposure prophylaxis
Pre-Exposure Prophylaxis - methods
Prevention
Preventive health services
pre‐exposure prophylaxis
Prophylaxis
Review
Reviews
Secondary data analysis
Viral Load
South Africa
United Kingdom
Sub-Saharan Africa
United Kingdom > UK
United States > US
Africa
pre-exposure prophylaxis
immediate antiretroviral therapy
Acute HIV infection
post-exposure prophylaxis
indeterminate HIV test
HIV testing algorithms
ISSN:1758-2652, 1758-2652
Online Access:Get full text
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Summary: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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ISSN:1758-2652
1758-2652
DOI:10.1002/jia2.25419