Decreased Time to Viral Suppression After Implementation of Targeted Testing and Immediate Initiation of Treatment of Acute Human Immunodeficiency Virus Infection Among Men Who Have Sex With Men in Amsterdam
Maartje Dijkstra, Martijn S. van Rooijen, M Hillebregt, Ard van Sighem, Colette Smit, Arjan Hogewoning, Udi Davidovich, Titia Heijman, Elske Hoornenborg, Peter Reiss, Marc van der Valk, Maria Prins, Jan M. Prins, Maarten F. Schim van der Loeff, Godelieve J. de Bree, HIV Transmission Elimination Amsterdam (H-TEAM) Initiative, Jan van Bergen, P. Brokx, F. Deug, M. Heidenrijk, Maria Prins, Peter Reiss, Marc van der Valk, Jan van Bergen, Godelieve J. de Bree, P. Brokx, Udi Davidovich, Suzanne E. Geerlings, Elske Hoornenborg, A. W. G. J. Oomen, Ard van Sighem, Wim Zuilhof, Nina Schat, Roel Achterbergh, Michiel A. van Agtmael, J. Ananworanich, Diederik van de Beek, G.E.L. van den Berk, Daniela Bezemer, A van Bijnen, Willem L. Blok, S Bogers, Marije K. Bomers, Charles A. Boucher, W. Brokking, David M. Burger, Kees Brinkman, Nathan Brinkman, Marijn de Bruin, Sylvia M. Bruisten, Liza Coyer, Reinout van Crevel, Ceranza G. Daans, L. Dellemann, Maartje Dijkstra, Y. T. van Duijnhoven, A. van Eeden, L. Elsenburg, Mark A. M. van den Elshout, Carmen Ester, Etem Erdal Erşan, P. E. V. Felipa, P. H. J. Frissen, Teunis B. H. Geijtenbeek, Mieke H. Godfried, Juna Goo, Abraham Goorhuis, M. de Groot, Catherine Hankins, A. Heijnen, M M J Hillebregt, A.A. Hogewoning, M. Hommenga, Joppe W. Hovius, Y. J. H. Janssen, K. De Jong, Vita W. Jongen, Neeltje A. Kootstra, Richard A. Koup, Frank P. Kroon, Thijs van de Laar, Fanny N. Lauw, Merle M. van Leeuwen, Kamilla D. Lettinga, Ineke Linde, Dominique Loomans, J. T. van der Meer, T. Mouhebati, Barbara J.M. Mulder, John Mulder, F.J.B. Nellen, A. Nijsters, H. Nobel, Paul M. Oostvogel, Eline Op de Coul, Elma Peters, I. S. Peters, Tom van der Poll, Oliver Ratmann, Casper Rokx
Abstract
BACKGROUND: Men who have sex with men (MSM) with acute human immunodeficiency virus (HIV) infection (AHI) are a key source of new infections. To curb transmission, we implemented a strategy for rapid AHI diagnosis and immediate initiation of combination antiretroviral therapy (cART) in Amsterdam MSM. We assessed its effectiveness in diagnosing AHI and decreasing the time to viral suppression. METHODS: We included 63 278 HIV testing visits in 2008-2017, during which 1013 MSM were diagnosed. Standard of care (SOC) included HIV diagnosis confirmation in < 1 week and cART initiation in < 1 month. The AHI strategy comprised same-visit diagnosis confirmation and immediate cART. Time from diagnosis to viral suppression was assessed for 3 cART initiation periods: (1) 2008-2011: cART initiation if CD4 < 500 cells/μL (SOC); (2) January 2012-July 2015: cART initiation if CD4 < 500 cells/μL, or if AHI or early HIV infection (SOC); and (3a) August 2015-June 2017: universal cART initiation (SOC) or (3b) August 2015-June 2017 (the AHI strategy). RESULTS: Before implementation of the AHI strategy, the proportion of AHI among HIV diagnoses was 0.6% (5/876); after implementation this was 11.0% (15/137). Median time (in days) to viral suppression during periods 1, 2, 3a, and 3b was 584 (interquartile range [IQR], 267-1065), 230 (IQR, 132-480), 95 (IQR, 63-136), and 55 (IQR, 31-72), respectively (P < .001). CONCLUSIONS: Implementing the AHI strategy was successful in diagnosing AHI and significantly decreasing the time between HIV diagnosis and viral suppression.