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Review
. 2015 Jan;10(1):61-8.
doi: 10.1097/COH.0000000000000121.

How can we better identify early HIV infections?

Nora E Rosenberg  1 , Christopher D Pilcher, Michael P Busch, Myron S Cohen
Affiliations
Review

How can we better identify early HIV infections?

Nora E Rosenberg et al. Curr Opin HIV AIDS. 2015 Jan.

Abstract

Purpose of review: Detection of early HIV infections (EHIs), including acute HIV infection (AHI), is important for individual health, prevention of HIV transmission, and measurement of HIV incidence. We describe markers of EHI, diagnostic strategies for detecting these markers, and ways to incorporate these strategies into diagnostic and HIV incidence algorithms.

Recent findings: For individual diagnosis in the USA and Europe, laboratory-based diagnostic algorithms increasingly incorporate fourth-generation HIV antigen tests, allowing for earlier detection. In some sub-Saharan African settings, symptom-based screening is being explored to identify subsets of persons at high risk for AHI. Point-of-care diagnostics designed for AHI detection are in the pipeline and, if validated, represent an opportunity for real-time AHI diagnosis. At the population level, multiassay algorithms are promising new strategies for estimating HIV incidence on the basis of several assays applied to cross-sectional samples. These algorithms can be developed to optimize performance, in addition to cost and logistical considerations.

Summary: There are important recent advances in detection of EHIs at the individual and population levels. Applying optimal combinations of tests in diagnostic and HIV incidence algorithms is urgently needed to support the multiple goals derived from enhanced detection and discrimination of EHIs.

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Conflict of interest statement

Conflicts of interest: M.S.C. has consulted with Roche Molecular Systems, the Bill and Melinda Gates Foundation, and Janssen Global Services.

Figures

Figure 1
Figure 1
Timing of early HIV infection biomarkers and symptoms. This figure depicts the trajectories of CD4 count, the appearance of HIV antibodies and symptoms, and blood and genital shedding soon after HIV infection. Black bars indicate timing of detection. Reproduced from [35].
Figure 2
Figure 2
Updated testing algorithm for US HIV diagnosis. This figure depicts the algorithm issued by the Centers for Disease Control and Prevention for HIV diagnostic testing in the United States in 2014. It distinguishes HIV-1 from HIV-2 and acute HIV infection from established HIV infection. Reproduced from [74••].
See this image and copyright information in PMC

References

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