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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Vydáno v:	Journal of the International AIDS Society Ročník 22; číslo 12; s. e25419 - n/a
Hlavní autoři:	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
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Switzerland International AIDS Society 01.12.2019 John Wiley & Sons, Inc John Wiley and Sons Inc
Témata:	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
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Popis
Shrnutí:	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.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Review-3 content type line 23
ISSN:	1758-2652 1758-2652
DOI:	10.1002/jia2.25419