将急性HIV筛查纳入马拉维利隆圭性传播感染诊所及HIV检测与咨询中心的常规HIV检测中。
Incorporating Acute HIV Screening into Routine HIV Testing at Sexually Transmitted Infection Clinics, and HIV Testing and Counseling Centers in Lilongwe, Malawi.
作者信息
Rutstein Sarah E, Pettifor Audrey E, Phiri Sam, Kamanga Gift, Hoffman Irving F, Hosseinipour Mina C, Rosenberg Nora E, Nsona Dominic, Pasquale Dana, Tegha Gerald, Powers Kimberly A, Phiri Mcleod, Tembo Bisweck, Chege Wairimu, Miller William C
机构信息
*Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC; †Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC; ‡Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; §Lighthouse Trust, Lilongwe, Malawi; ‖UNC Project, Lilongwe, Malawi; and ¶Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.
出版信息
J Acquir Immune Defic Syndr. 2016 Mar 1;71(3):272-80. doi: 10.1097/QAI.0000000000000853.
BACKGROUND AND OBJECTIVES
Integrating acute HIV-infection (AHI) testing into clinical settings is critical to prevent transmission, and realize potential treatment-as-prevention benefits. We evaluated acceptability of AHI testing and compared AHI prevalence at sexually transmitted infection (STI) clinics and HIV testing and counseling (HTC) clinics in Lilongwe, Malawi.
METHODS
We conducted HIV RNA testing for HIV-seronegative patients visiting STI and HTC clinics. AHI was defined as positive RNA and negative/discordant rapid antibody tests. We evaluated demographic, behavioral, and transmission-risk differences between STI and HTC patients and assessed performance of a risk-score for targeted screening.
RESULTS
Nearly two-thirds (62.8%, 9280/14,755) of eligible patients consented to AHI testing. We identified 59 persons with AHI (prevalence = 0.64%)-a 0.9% case-identification increase. Prevalence was higher at STI [1.03% (44/4255)] than at HTC clinics [0.3% (15/5025), P < 0.01], accounting for 2.3% of new diagnoses vs 0.3% at HTC clinic. Median viral load (VL) was 758,050 copies per milliliter; 25% (15/59) had VL ≥ 10,000,000 copies per milliliter. Median VL was higher at STI (1,000,000 copies/mL) compared with HTC (153,125 copies/mL, P = 0.2). Among persons with AHI, those tested at STI clinics were more likely to report genital sores compared with those tested at HTC clinics (54.6% vs 6.7%, P < 0.01). The risk score algorithm performed well in identifying persons with AHI at HTC clinics (sensitivity = 73%, specificity = 89%).
CONCLUSIONS
The majority of patients consented to AHI testing. AHI prevalence was substantially higher in STI clinics than HTC clinics. Remarkably high VLs and concomitant genital scores demonstrate the potential for transmission. Universal AHI screening at STI clinics, and targeted screening at HTC centers, should be considered.
背景与目的
将急性HIV感染（AHI）检测纳入临床诊疗对于预防传播以及实现潜在的治疗即预防效益至关重要。我们评估了AHI检测的可接受性，并比较了马拉维利隆圭性传播感染（STI）诊所和HIV检测与咨询（HTC）诊所的AHI患病率。
方法
我们对前往STI和HTC诊所就诊的HIV血清阴性患者进行了HIV RNA检测。AHI定义为RNA阳性且快速抗体检测呈阴性/不一致。我们评估了STI患者和HTC患者在人口统计学、行为学及传播风险方面的差异，并评估了用于靶向筛查的风险评分的性能。
结果
近三分之二（62.8%，9280/14755）符合条件的患者同意进行AHI检测。我们识别出59例AHI患者（患病率 = 0.64%）——病例识别率提高了0.9%。STI诊所的患病率[1.03%（44/4255）]高于HTC诊所[0.3%（15/5025），P < 0.01]，在新诊断病例中占2.3%，而在HTC诊所占0.3%。病毒载量（VL）中位数为每毫升758,050拷贝；25%（15/59）的患者VL≥每毫升10,000,000拷贝。与HTC诊所（每毫升153,125拷贝，P = 0.2）相比，STI诊所的VL中位数更高（每毫升1,000,000拷贝）。在AHI患者中，与在HTC诊所检测的患者相比，在STI诊所检测的患者更有可能报告有生殖器溃疡（54.6%对6.7%，P < 0.01）。风险评分算法在识别HTC诊所的AHI患者方面表现良好（敏感性 = 73%，特异性 = 89%）。
结论
大多数患者同意进行AHI检测。STI诊所的AHI患病率显著高于HTC诊所。极高的VL水平以及伴随的生殖器溃疡评分表明存在传播的可能性。应考虑在STI诊所进行普遍的AHI筛查，并在HTC中心进行靶向筛查。
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