Treatment of acute HIV infection: diagnostic trajectory and research

Recent studies have demonstrated that when people are treated in the very early stages of an HIV infection (i.e., during the acute infection phase), the virus remains under control in some of these people, even after they stop treatment. This is called ‘post-treatment control’. This only occurs in a very small number of individuals and it is unclear which factors contribute to this post-treatment control. The H-TEAM investigates the effect of very early treatment on the immune system and the virus in the NOVA study.
onderzoek

Diagnostic trajectory & NOVA cohort study

The study focuses on people living with HIV in the acute infection phase. This phase comprises the first weeks after infection has taken place. Identifying an acute HIV infection (AHI) is of great importance, as recent studies have demonstrated that starting ART in this phase improves the prognosis of people living with HIV in the long run. In addition, there is an increased risk of transmitting the virus during this first period. Identifying and treating an AHI is therefore beneficial for the individual and significantly reduces the risk of transmitting the virus to others.

This study comprises three components:
1. AHI diagnostic & referral trajectory
2. AHI diagnostic & linkage-to-care trajectory at the STI clinic Amsterdam
3. NOVA cohort study

Scroll down for more information on these components.

Approach

The recent development of point-of-care HIV RNA tests has made prompt diagnosis of AHI possible, but guidelines on whom to test for AHI are lacking. Therefore, the H-TEAM has developed an algorithm to assess the risk of an acute HIV infection.

 

Based on data from the Amsterdam Cohort Studies (ACS), literature, and expert opinion, an existing algorithm for possible AHI was evaluated. The risk score was optimized by including both symptoms associated with AHI and known risk factors for an HIV infection. The optimal risk score was validated using data of the Multicenter AIDS Cohort Study (MACS).

Results

The study showed that an adjusted algorithm for AHI including risk factors and symptoms performed better than a risk score including only symptoms. These findings have been published in a scientific article: ‘Development and validation of a risk score to assist screening for acute HIV-1 infection among men who have sex with men.’ This article can be found under Publications.

 

The study data indicate that screening for AHI with this optimal risk score would increase the efficiency of HIV RNA testing and potentially enhance early diagnosis and immediate treatment. Therefore, the H-TEAM has implemented the adjusted risk score using a step-wise approach at the Amsterdam STI clinic (as from May 2018). Through the hebikhiv.nl website, men who have recently been at risk can complete a Symptoms Check, which is based on the adjusted screening algorithm. If the Symptoms Check indicates that someone may have an acute HIV infection, he will be referred to Public Health Service Amsterdam (GGD Amsterdam). Read more about this campaign at Awareness Raising and Treatment.

 

The feasibility of the new AHI algorithm is currently being evaluated.

Approach

To enable rapid diagnosis, referral, treatment, and participation in the NOVA study, the H-TEAM has introduced a new rapid diagnostic service for acute HIV at the GGD and the DC Klinieken.

 

The hebikhiv.nl website provides visitors with information about the symptoms of an acute HIV infection. If a person recognizes AHI symptoms through the website, or if a general practitioner believes a person might have an acute HIV infection, they can visit the acute HIV service at the GGD or DC Klinieken. They will then be given a standard HIV test combined with a rapid, sensitive HIV RNA test the same day. If an acute HIV infection is detected, the person can start treatment that same day in one of the treatment centres in Amsterdam.

Results

Since the start of the trajectory the results have been positive: in the last few years, the test-positivity rate for acute HIV infections was about 8 percent of all those tested. In the coming year, the H-TEAM will explore whether the trajectory or elements of the trajectory and the communication campaign could be implemented on a national scale.

Approach

The H-TEAM’s NOVA study investigates the effects of very early treatment on characteristics of the immune system and the virus. These insights support the development of new treatment strategies – such as therapeutic vaccination or the application of broadly neutralizing antibodies – that can ensure that people living with HIV no longer need antiretroviral therapy (ART) over a long period of time and can suppress the virus by themselves without ART.

 

The NOVA study is carried out at the Amsterdam UMC – location AMC and the Erasmus MC, and at several other hospitals in the Netherlands: LUMC, RadboudumcMaasstad HospitalOLVG en DC Klinieken Amsterdam. People with an AHI who start treatment during the AHI phase are invited to participate in the NOVA study. After consenting to participating, they are included in the study.

Results

The NOVA study started in August 2015 and currently (mid 2019) over 100 individuals are participating in the research.

 

Nearly all of these people started HIV treatment on the day they were diagnosed, and the majority had an undetectable viral load after two months. We expect the first results of this group in the coming years.

Team

  • Annelies Verbon
    Annelies Verbon

    Member
    ErasmusMC

  • Casper Rokx
    Casper Rokx

    Member
    ErasmusMC

  • Charles Boucher
    Charles Boucher

    Member
    ErasmusMC

  • Jan Prins
    Jan Prins

    Member
    Amsterdam UMC

  • Godelieve de Bree
    Godelieve de Bree

    Project Leader
    Amsterdam UMC
    AIGHD

  • Maartje Dijkstra
    Maartje Dijkstra

    Member
    GGD Amsterdam