Acute and recent HIV infection Kristien Wouters¹, Ilse Kint¹, Eric Florence¹, Annelies Van Den Heuvel², Katrien Fransen², Olivier Koole¹ and Lutgarde Lynen¹ ¹ Institute of Tropical Medicine, Aids Reference Centre ² Institute of Tropical Medicine, Aids Reference Laboratory
Background Every year around 1000 new HIV-infections in Belgium At ITM: % of recent infections and acute seroconversions is increasing? At ITM: lack of standardized definitions and management of acute seroconversion and recent infections among clinicians
Objectives To determine the proportion of new and recent HIV infections among recently enrolled HIV+ patients To describe characteristics of those patients with regard to clinical, immunological, virological, behavioral aspects
Method Retrospective analysis Review of all new patients diagnosed at ITM ARL and ARC in 2010 Data retrieved from HIV database (ARC and ARL), completed by chart review (each physician) Data: WIV data + HIV test result (P24 Ag, HIV-AB, Inno- LIA bands) + CD4/CD8 + VL + risk behavior + history of STI + symptoms at presentation + last negative test
EACS definition acute primary HIV infection: High risk exposure within previous 2-8 weeks And clinical symptoms And detectable HIV (p24ag or HIV-RNA>10,000 copies/ml) And negative or indeterminate serologic Ab testing EACS: European AIDS Clinical Society
Results: Patient flow chart
Demographic characteristics Sex and sexual orientation Ethnic origin 82; 59% 35; 25% 22; 16% Male Hetero Female MSM 32; 23% 23; 17% 84; 60% Western Europe Sub Sahara Africa other
DEFINITIONS USED IN THE ANALYSIS Laboratory seroconversion (LAB): identified by lab (negative bands in LIA) Clinical seroconversion syndrome (CLIN): Clinical symptoms compatible with seroconversion, but already some positive bands in LIA Recent infection (REC): Already some positive bands in LIA, but recent negative test or history of seroconversion syndrome in past 6 months Chronic infection: older than 6M
Acute and Recent HIV Number of patients Clinical symptoms High risk contact 2-8w Last neg test <6m LAB 14 10 7 6 CLIN 23 23 12 5 REC 11 0 7 4 CHRON 91 14 12 0 Total 139 Targeting prevention efforts 48/139 acute and recent infections (35%) Male: 94% (45) Origin: Western Europe: 85% MSM: 79%
Documented STI in last 3M Total persons with STI NGU Acute HCV Acute HBV LGV Gonorrhoea Chlamydia Syphilis 0% 2% 0% 2% 0% 2% 0% 6% 2% 4% 1% 6% 12% 11% 23% 33% Chronic hiv infection Acute and recent hiv infection 0% 5% 10% 15% 20% 25% 30% 35%
How to better identify patients with clinical seroconversion and/or recent infection? Extra laboratory information? Different bands in LIA are still negative or indeterminate in clinical seroconversions and recent infections (gp120, p31, p17) CD8 >= 1500 cells/µl High CD4 count High VL Clinical seroconversion symptoms
Limitations Retrospective study Recall bias on sexual risk behavior 1 ARC/ARL
Conclusions 1/3 of new HIV+ patients presenting at ITM in 2010 are acute or recent infections Only 1/3 of these are diagnosed through LAB seroconversion parameters (EACS) Combined clinical and laboratory information is needed to identify correctly recent infections
Conclusions Patients with recent infections can be a specific group for targeted prevention messages Management of recent infections is still unclear: when to treat 20% of new diagnosis do not present for care in Antwerp what has happened?
The way forward Prospective observational study Multicentric Protocol will be submitted in next Breach meeting -> invitation to participate Please contact us: kwouters@itg.be