How can we better identify early HIV infections?
OBJECTIVE
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.


RESULTS
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.


CONCLUSIONS
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.
aDivision of Infectious Diseases, University of North Carolina, Chapel Hill, USA bUniversity of North Carolina Project, University of North Carolina, Lilongwe, Malawi cSchool of Medicine, University of California at San Francisco dBlood Systems Research Institute, San Francisco, California, USA.
Nora E
NE
Rosenberg
Christopher D
CD
Pilcher
Michael P
MP
Busch
Myron S
MS
Cohen
D000465:Algorithms; D015415:Biomarkers / Q000032:analysis; D003695:Delivery of Health Care; D042241:Early Diagnosis; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism; D006801:Humans; D019095:Point-of-Care Systems
D015415:Biomarkers