ICAP at Columbia University, New York, New York, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
AIDS Res Hum Retroviruses. 2022 Nov;38(11):834-839. doi: 10.1089/AID.2021.0216. Epub 2022 Sep 1.
In Africa, rapid testing for recent HIV infection (RTRI) is being scaled up; however, use of the recent infection testing algorithm (RITA), which uses viral load (VL) to confirm RTRI-recent infections, is not a widespread practice. We present results of recently acquired HIV infections among men who have sex with men (MSM), transgender women, and genderqueer (TGW/GQ) individuals with newly diagnosed HIV infection in Zimbabwe as per the national approach (RTRI) and applying a RITA. In 2019, 1,538 MSM and TGW/GQ in Harare and Bulawayo, Zimbabwe were recruited to participate in a biobehavioral survey using respondent-driven sampling. Consenting participants received HIV testing and all HIV-positive specimens were tested with the RTRI Asanté HIV-1 Rapid Recency Assay, and for VL and CD4 count. RTRI-recent participants with unsuppressed VL (≥1,000 copies/mL) were classified as RITA-recent. Descriptive statistics were used to summarize results among RTRI-recent and RITA-recent participants. Among those tested for HIV (1,511/1,538), 22.5% (340/1,511) tested positive and of those, 55.0% (187/340) self-reported an HIV-negative or unknown status. Among these, 8.6% (16/187) were classified as RTRI-recent and 91.4% (171/187) were classified as RTRI-long term. After accounting for VL, RITA-recency was 1.1% (2/187). Two of 16 (12.5%) RTRI-recent infections were RITA-recent. VL among RITA-recent cases were 9,052 copies/mL and 40,694 copies/mL and both had CD4 counts <500. Data highlight misclassification of recent infections among MSM and TGW/GQ with newly diagnosed HIV infection using RTRI. With the incorporation of VL, >85% of RTRI-recent cases were reclassified as RITA-long term. True characterization of recent infections may not be possible without VL testing, which remains challenging in resource-limited settings.
在非洲，快速检测近期 HIV 感染（RTRI）正在得到推广；然而，使用最近感染检测算法（RITA）来确认 RTRI-近期感染的做法并不普遍。我们根据国家方法（RTRI）和应用 RITA，报告了津巴布韦新诊断为 HIV 感染的男男性行为者（MSM）、跨性别女性和性别酷儿（TGW/GQ）个体中新获得的 HIV 感染的结果。2019 年，在津巴布韦哈拉雷和布拉瓦约，招募了 1538 名 MSM 和 TGW/GQ 参与一项使用应答驱动抽样的生物行为调查。同意参与的参与者接受了 HIV 检测，所有 HIV 阳性标本均用 RTRI Asanté HIV-1 快速近期确证检测进行了检测，并检测了病毒载量（VL）和 CD4 计数。VL（≥1000 拷贝/ml）未抑制的 RTRI-近期参与者被归类为 RITA-近期。使用描述性统计方法总结了 RTRI-近期和 RITA-近期参与者的结果。在接受 HIV 检测的 1511 人（1538 人）中，22.5%（340 人）检测结果为阳性，其中 55.0%（187 人）自我报告 HIV 阴性或未知。在这些人中，8.6%（16 人）被归类为 RTRI-近期，91.4%（171 人）被归类为 RTRI-长期。考虑到 VL 后，RITA 近期率为 1.1%（187 人）。16 名 RTRI-近期感染者中有 2 名（12.5%）为 RITA-近期。2 例 RITA-近期病例的 VL 分别为 9052 拷贝/ml 和 40694 拷贝/ml，且均有 CD4 计数<500。数据显示，使用 RTRI 检测新诊断为 HIV 感染的 MSM 和 TGW/GQ 中的近期感染存在误诊。结合 VL 检测，超过 85%的 RTRI-近期病例被重新归类为 RITA-长期。如果没有 VL 检测，就不可能对近期感染进行真正的特征描述，而在资源有限的情况下，VL 检测仍然具有挑战性。
