scholarly journals Implementing Rapid Initiation of Antiretroviral Therapy for Acute HIV Infection Within a Routine Testing and Linkage to Care Program in Chicago

2020 ◽  
Vol 19 ◽  
pp. 232595822093975
Author(s):  
Moira McNulty ◽  
Jessica Schmitt ◽  
Eleanor Friedman ◽  
Bijou Hunt ◽  
Audra Tobin ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Viral Suppression ◽  
Linkage To Care ◽  
Care Program ◽  
Acute Hiv Infection ◽  
Screening Programs ◽  
Acute Hiv ◽  
Therapy Clients

Growing evidence suggests that rapid initiation of antiretroviral therapy for HIV improves care continuum outcomes. We evaluated process and clinical outcomes for rapid initiation in acute HIV infection within a multisite health care–based HIV testing and linkage to care program in Chicago. Through retrospective analysis of HIV testing data (2016-2017), we assessed linkage to care, initiation of antiretroviral therapy, and viral suppression. Of 334 new HIV diagnoses, 33 (9.9%) individuals had acute HIV infection. Median time to linkage was 11 (interquartile range [IQR]: 5-19.5) days, with 15 days (IQR 5-27) to initiation of antiretroviral therapy. Clients achieved viral suppression at a median of 131 (IQR: 54-188) days. Of all, 69.7% were retained in care, all of whom were virally suppressed. Sites required few additional resources to incorporate rapid initiation into existing processes. Integration of rapid initiation of antiretroviral therapy into existing HIV screening programs is a promising strategy for scaling up this important intervention.

scholarly journals 562. Management and Outcomes of Patients With Acute HIV Infection in an Expanded Testing and Linkage to Care Program

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S208-S209
Author(s):  
Moira C McNulty ◽  
Jessica Schmitt ◽  
Eleanor Friedman ◽  
Bijou Hunt ◽  
Audra Tobin ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Linkage To Care ◽  
Care Program ◽  
Acute Hiv Infection ◽  
Acute Hiv

scholarly journals LB-6. Increased Diagnoses of Acute HIV Infection through Routine ED Screening and Rapid Linkage to Care and initiation of HAART During the COVID-19 Pandemic

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S846-S846
Author(s):  
Kimberly Stanford ◽  
Jessica Schmitt ◽  
Michelle M Taylor ◽  
Dylan Eller ◽  
Eleanor Friedman ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Linkage To Care ◽  
Cook County ◽  
Hiv Screening ◽  
Acute Hiv Infection ◽  
Screening Programs ◽  
First Case ◽  
Number Of Patients ◽  
Advanced Planning ◽  
Acute Hiv

Abstract Background The COVID-19 pandemic has negatively impacted routine HIV screening in healthcare settings. This has serious implications, especially for patients with acute HIV infection (AHI) presenting with symptoms suggesting COVID-19 infection. This is a high priority population for rapid linkage to care (LTC) and initiation of HAART. Methods We reviewed data from our eXpanded HIV Testing and LTC (X-TLC) Program, a collaboration effort between 13 healthcare centers on the South and West Sides of Chicago. Since 2016, most sites had 4th or 5th generation HIV Ag/Ab testing available. Results Most sites experienced reductions in HIV screens during the COVID-19 pandemic. Advanced planning by our ED incorporated blood draws for HIV screens as part of COVID-19 evaluations. UCM performed 19,111 HIV screens (11,133 in the ED) between 1/1/20 and 8/17/20, along with 100,635 COVID PCRs (14,754 in ED) between 3/17/20 and 8/17/20. Nine patients were diagnosed with AHI after the first case of COVID-19 in Chicago (1/24/20), and 7 were diagnosed after the first case of community transmission in Cook County (3/8/20). All cases of AHI were diagnosed in the ED. The rate of AHI was significantly higher in 2020 versus the prior 4 years (14.4 vs 6.8 per year, p < 0.05). AHI patients comprised 25.7 % (9/35) of all new diagnoses, the highest percent ever. There were 7 men (6 identified as MSM) and 2 cis-gender women, median age of 25 years (21 to 28 years). The median viral load was 6 million (115,000 to > 6 million) copies/mL. Eight of 9 patients presented with an illness indistinguishable from COVID-19, including 1co-infected patient. All were LTC and started on HAART from time of PCR result within a median of 1 day (0–38), but 3 days (range 1–41) from sample collection as a result of delayed reflex PCR confirmatory testing due to high demands on lab personnel and scarcity of reagents due to COVID-19 PCR volumes (since resolved). HIV Screening and COVID-19 Testing in the ED During COVID-19 Conclusion Continued HIV screening in our ED during the COVID-19 pandemic identified an increased number of patients with AHI. These individuals may be more likely to present for care due to fear of COVID-19 infection. We achieved rapid LTC and initiation of HAART without any incremental increases in resources. All HIV screening programs should incorporate blood-based HIV screening into their COVID-19 testing programs. Disclosures Moira McNulty, MD, MS, Gilead Sciences (Grant/Research Support)

scholarly journals Viral Dynamics of Acute HIV-1 Infection

1999 ◽  
Vol 190 (6) ◽  
pp. 841-850 ◽  
Author(s):  
Susan J. Little ◽  
Angela R. McLean ◽  
Celsa A. Spina ◽  
Douglas D. Richman ◽  
Diane V. Havlir
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Doubling Time ◽  
Basic Reproductive Number ◽  
Reproductive Number ◽  
Target Cells ◽  
Viral Dynamics ◽  
Acute Hiv Infection ◽  
Acute Hiv ◽  
The Mean

Viral dynamics were intensively investigated in eight patients with acute HIV infection to define the earliest rates of change in plasma HIV RNA before and after the start of antiretroviral therapy. We report the first estimates of the basic reproductive number (R0), the number of cells infected by the progeny of an infected cell during its lifetime when target cells are not depleted. The mean initial viral doubling time was 10 h, and the peak of viremia occurred 21 d after reported HIV exposure. The spontaneous rate of decline (α) was highly variable among individuals. The phase 1 viral decay rate (δI = 0.3/day) in subjects initiating potent antiretroviral therapy during acute HIV infection was similar to estimates from treated subjects with chronic HIV infection. The doubling time in two subjects who discontinued antiretroviral therapy was almost five times slower than during acute infection. The mean basic reproductive number (R0) of 19.3 during the logarithmic growth phase of primary HIV infection suggested that a vaccine or postexposure prophylaxis of at least 95% efficacy would be needed to extinguish productive viral infection in the absence of drug resistance or viral latency. These measurements provide a basis for comparison of vaccine and other strategies and support the validity of the simian immunodeficiency virus macaque model of acute HIV infection.

scholarly journals Efficacy, pharmacokinetics and neurocognitive performance of dual, NRTI-sparing antiretroviral therapy in acute HIV-infection

AIDS ◽  
2020 ◽  
Vol 34 (13) ◽  
pp. 1923-1931
Author(s):  
Cynthia L. Gay ◽  
Dayna T. Neo ◽  
Aaron S. Devanathan ◽  
Joann D. Kuruc ◽  
Kara S. McGee ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Neurocognitive Performance ◽  
Acute Hiv Infection ◽  
Acute Hiv

scholarly journals Efficacy of NNRTI-based antiretroviral therapy initiated during acute HIV infection

AIDS ◽  
2011 ◽  
pp. 1 ◽  
Author(s):  
Cynthia L Gay ◽  
Ashley J Mayo ◽  
Chelu K Mfalila ◽  
Haitao Chu ◽  
Anna C Barry ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Acute Hiv Infection ◽  
Acute Hiv

scholarly journals Normalization of Soluble CD163 Levels After Institution of Antiretroviral Therapy During Acute HIV Infection Tracks with Fewer Neurological Abnormalities

2018 ◽  
Vol 218 (9) ◽  
pp. 1453-1463 ◽  
Author(s):  
Michelle L D’Antoni ◽  
Mary Margaret Byron ◽  
Phillip Chan ◽  
Napapon Sailasuta ◽  
Carlo Sacdalan ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Acute Hiv Infection ◽  
Soluble Cd163 ◽  
Neurological Abnormalities ◽  
Acute Hiv

scholarly journals Decreased Seroreactivity in Individuals Initiating Antiretroviral Therapy during Acute HIV Infection

2019 ◽  
Vol 57 (10) ◽  
Author(s):  
Mark M. Manak ◽  
Linda L. Jagodzinski ◽  
Ashley Shutt ◽  
Jennifer A. Malia ◽  
Mike Leos ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Western Blot ◽  
Research Collaboration ◽  
Virologic Suppression ◽  
Infection Status ◽  
Acute Hiv Infection ◽  
Western Blot Assay ◽  
Acute Hiv ◽  
Hiv 1

ABSTRACTAntiretroviral therapy (ART) during acute HIV infection (AHI) interrupts viral dynamics and may delay the emergence of serological markers targeted by current HIV screening and confirmatory assays, thus creating challenges for correctly classifying HIV infection status. The performance of three HIV antigen/antibody combination (HIV Ag/Ab Combo) assays (the Bio-Rad GS, Abbott Architect, and Bio-Rad BioPlex 2200 assays) was evaluated with samples collected from RV254/South East Asia Research Collaboration in HIV 010 (RV254/SEARCH010) study (Bangkok, Thailand) participants at weeks 12 and 24 following the initiation of ART at Fiebig stage I (FI) (n = 23), FII (n = 39), or FIII/IV (n = 22). Supplemental, confirmatory testing was performed by the Geenius HIV 1/2 and HIV-1 Western blot assays (Bio-Rad). Samples from 30 untreated, HIV-1-infected individuals demonstrated robust HIV Ag/Ab Combo assay reactivity with well-developed HIV-1 Western blotting profiles by 24 weeks after infection. In contrast, 52.2% of samples from individuals initiating ART at FI, 7.7% of samples from individuals initiating ART at FII, and 4.5% of samples from individuals initiating ART at FIII/IV were nonreactive by the HIV Ag/Ab Combo assays, with 36.4 to 39.1% of samples having low signal-to-cutoff (S/CO) results by the Architect and BioPlex assays (S/CO < 10). Seroreversion from a reactive to a nonreactive status was observed in 10 individuals initiating ART at FII and 3 individuals initiating ART at FIII/IV. The Geenius and HIV-1 Western blot assay results were negative or indeterminate for 73.9% and 69.6% of individuals, respectively, treated at FI; 50.0% and 26.3% of individuals, respectively, treated at FII; and 54.5% and 40.9% of individuals, respectively, treated at FIII/IV. Virologic suppression of HIV-1 by ART during AHI impedes seroconversion to biomarkers of infection, limiting the utility of HIV Ag/Ab Combo and supplemental, confirmatory assays for infection status determination.

Benefits of antiretroviral therapy initiation during acute HIV infection

2020 ◽  
pp. 1-9
Author(s):  
Jozefien De Clercq ◽  
Sofie Rutsaert ◽  
Marie-Angélique De Scheerder ◽  
Chris Verhofstede ◽  
Steven Callens ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Acute Hiv Infection ◽  
Therapy Initiation ◽  
Acute Hiv

scholarly journals Acute HIV infection: Improved algorithms for HIV testing

2015 ◽  
Vol 63 ◽  
pp. 51-52 ◽  
Author(s):  
Valeria Ghisetti ◽  
Andrea Calcagno ◽  
Elisa Burdino ◽  
Giancarlo Orofino ◽  
Stefano Bonora
Keyword(s):  
Hiv Infection ◽  
Hiv Testing ◽  
Acute Hiv Infection ◽  
Acute Hiv
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