Diagnosing established and acute HIV in the context of facility-based HIV testing services in rural Eswatini: a cross-sectional study.

IF 3 3区医学 Q2 INFECTIOUS DISEASES

Sexually Transmitted Infections Pub Date : 2026-06-05 DOI:10.1136/sextrans-2025-056838

Iza Ciglenecki, Bernhard Kerschberger, Esther Mukooza, Skinner Lekelem, Nombuso Ntshalintshali, Mpumelelo Mavimbela, Sindisiwe Dlamini, Lenhle Dube, Nomvuyo Mabuza, Roberto de Latour, Melat Haile, Tom Ellman, Olivia Keiser, Niklaus Daniel Labhardt, Sindy Matse, Alexandra Calmy

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引用次数: 0

Abstract

Introduction: Acute HIV infection (AHI) is the brief period between viral acquisition and the appearance of HIV antibodies and cannot be detected by routinely used HIV rapid diagnostic tests (RDTs). Its role is likely to become increasingly important in the rapidly changing context of HIV testing in high-burden countries. We describe the characteristics of individuals attending HIV testing services (HTS) in rural Eswatini and the prevalence of newly diagnosed HIV, including AHI.

Methods: Adults aged ≥18 years were enrolled at six routine HTS between June 2022 and April 2023. Participants completed detailed questionnaires. Routine HIV testing was conducted using the national serial RDT algorithm (Determine and Uni-Gold). HIV viral load (VL) analysis was performed on the Xpert platform (Xpert HIV-1 Viral Load, Cepheid) in the central laboratory. Newly diagnosed HIV was defined as a positive HIV RDT algorithm with detectable VL (established HIV), or negative or discordant HIV RDT together with VL ≥10 000 copies/mL (AHI).

Results: Of 1095 participants with a median age of 27 years (IQR 22-33), 684 (61.5%) were women. Risk factors for HIV acquisition were common: >1 sexual partner (332, 30.3%), condomless sex (452, 44.5%), not knowing main partner's HIV status (437, 42.8%). Symptoms consistent with AHI (713, 65.1%) and genito-urinary (660, 60.3%) infections were common. Overall, 41 participants (3.7%, 95% CI 2.7% to 5.0%) were diagnosed with HIV; 31 (2.8%, 95% CI 1.9% to 3.9%) with established HIV and 10 (0.9%, 95% CI 0.04% to 1.7%) with AHI, representing 24.4% (95% CI 12.4% to 40.3%) of new diagnoses. All participants diagnosed with AHI reported symptoms consistent with AHI.

Conclusions: Our study among a general adult population attending HTS revealed a high overall HIV prevalence with a substantial proportion of AHI, highlighting the decreasing sensitivity of routine HTS to detect all HIV infections. To address AHI, accurate and accessible diagnostic tools and AHI testing guidance are needed.

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在斯瓦蒂尼农村地区基于设施的艾滋病毒检测服务背景下诊断确诊和急性艾滋病毒：一项横断面研究。

急性HIV感染（AHI）是指从病毒获得到出现HIV抗体之间的短暂时期，不能通过常规使用的HIV快速诊断测试（RDTs）检测到。在高负担国家艾滋病毒检测迅速变化的背景下，它的作用可能变得越来越重要。我们描述了在斯瓦蒂尼农村参加艾滋病毒检测服务（HTS）的个体的特征和新诊断的艾滋病毒的流行，包括AHI。方法：在2022年6月至2023年4月期间，年龄≥18岁的成年人参加了6次常规HTS。参与者完成了详细的问卷调查。常规HIV检测采用国家串行RDT算法（确定和Uni-Gold）。在中心实验室的Xpert平台（Xpert HIV-1 viral load, Cepheid）上进行HIV病毒载量（VL）分析。新诊断的HIV定义为HIV RDT算法阳性且可检测到VL（已确定的HIV），或HIV RDT阴性或不一致且VL≥10,000拷贝/mL （AHI）。结果：1095名中位年龄为27岁（IQR 22-33）的参与者中，684名（61.5%）为女性。感染艾滋病毒的危险因素有：无性伴侣（332人，30.3%）、无安全套性行为（452人，44.5%）、不了解主要伴侣的艾滋病毒感染情况（437人，42.8%）。症状与AHI（713例，65.1%）和泌尿生殖系统感染（660例，60.3%）一致。总体而言，41名参与者（3.7%,95% CI 2.7%至5.0%）被诊断为艾滋病毒；31人（2.8%,95% CI 1.9%至3.9%）确诊为HIV， 10人（0.9%,95% CI 0.04%至1.7%）患有AHI，占新诊断的24.4% （95% CI 12.4%至40.3%）。所有被诊断为AHI的参与者报告的症状与AHI相符。结论：我们在参加HTS的普通成人人群中进行的研究显示，总体艾滋病毒感染率较高，AHI占很大比例，突出了常规HTS检测所有艾滋病毒感染的敏感性降低。为了解决AHI问题，需要准确和方便的诊断工具和AHI检测指南。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Sexually Transmitted Infections 医学-传染病学

CiteScore

5.70

自引率

8.30%

发文量

审稿时长

4-8 weeks

期刊介绍： Sexually Transmitted Infections is the world’s longest running international journal on sexual health. It aims to keep practitioners, trainees and researchers up to date in the prevention, diagnosis and treatment of all STIs and HIV. The journal publishes original research, descriptive epidemiology, evidence-based reviews and comment on the clinical, public health, sociological and laboratory aspects of sexual health from around the world. We also publish educational articles, letters and other material of interest to readers, along with podcasts and other online material. STI provides a high quality editorial service from submission to publication.