Front Immunol: A comparison of HIV self-testing and institutional testing methods for early HIV detection in men who have sex with men

Background: In 2020, UN Member States committed to implement 17 Sustainable Development Goals (SDGs), one of which is a motivation/goal to end the AIDS epidemic by 2030 by using a fast-track approach, target 95-95-95: By 2030, 95% of people living with HIV (PLWH) should know their HIV status, 95% of people who know their status should receive antiretroviral treatment (ART), and 95% of people who are being treated should be suppressed
by the virus.
Acute primary HIV infection, also known as early HIV infection (EHI), is the early stage
of HIV infection.
In the presence of both HIV RNA and p24 antigens, acute HIV infection occurs 2-4 weeks after infection and primary HIV infection occurs 6 months after
infection.
The high concentration of the virus during EHI leads to an increase in infectivity, which can be 26 times higher
during chronic infection.
Improving EHI case recognition is important for HIV infection management to achieve this goal by 2030
.
However, in China, only 68% of people living with HIV knew their serological status
at the end of 2015.
In some provinces with high HIV prevalence, only 15% of confirmed cases are EHI, meaning that most cases are diagnosed late
.
Therefore, effective methods are needed to identify epidemic haemorrhagic fevers
early.

Over the past few years, several laboratory-based tests have been tested to identify early HIV infection
based on the natural serological response to infection.
However, they are based on demographic data
.
When applied to individuals, false-positive results
that classify long-term infection as recent infection may occur.
Therefore, the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommend the use of the latest Infection Detection Algorithm (RITA), which combines
new HIV testing with multiple routinely used clinical tests, to improve accuracy.
In other words, RITA is a combination
of laboratory tests used to classify HIV infection as recent (most recent infection is usually acquired within 4 to 12 months) or long-term.
Restriction antigen affinity enzyme immunoassay (LAG-EIA) is one of
the most widely used serological methods for the identification of EHI.
CD4+ T cell count and viral load (VL) tests are two other clinical tests used by most RITA to reclassify recent infections
.
Compared to the classification of newly infected HIV using serological methods alone, RITAS combines a variety of clinical information and analysis of newly infected HIV has been shown to accurately classify recently infected cases and effectively reduce the incidence of pseudo-newness (FRR).

Methods: A cross-sectional study was conducted in men who have sex with men (MSM) using online questionnaires (including sociodemographic, sexual biography, and HIV testing history information) and blood samples (for restriction antigen affinity enzyme immunoassays, genotype testing, and testing for confirmed HIV diagnosis).

To compare men who have sex with men who have been diagnosed HIV-positive for the first time through HIV transmission route and HIV transmission
.
Chi-square test or Fisher's exact test is used to explore any association
between two groups and their subgroups.

Results: From 2017 to 2021, a total of 124 cases of HIV infection among men who have sex with men were found in Zhuhai, China, of which 60 cases were detected through HIV transmission and 64 cases were detected
through HIV transmission.
Compared to MSM cases identified by HIVFBT, participants in the HIVST group were younger (≤ 30 years old, 76.
7% versus 46.
9%), more educated (> high school, 61.
7% versus 39.
1%), and had a higher viral load (≥ 1000 copies/ml, 71.
7% versus 50.
0%)
。 Using four state-of-the-art infection detection algorithms (RITAs), the proportion of early HIV infection was higher in the HIVST group than in the HIVFBT group (RITA 1, 46.
7% versus 25.
0%; RITA 2, 43.
3% vs.
20.
3%; RITA 3, 30.
0% vs.
14.
1%; RITA 4, 26.
7% vs.
10.
9%; All P<0.
05).

Table 1 Using different recent infection detection algorithms (RITA) to investigate HIV infection status among HIV-positive men who have sex with men in Zhuhai, China
.

Table 2 Sociodemographic characteristics of HIV-positive men who have sex with men in the new test results of different new infection detection algorithms (RITA) in Zhuhai, China
.

Table 3 Univariate and multivariate Lo gistic analysis of factors associated with recent HIV infection in RITA 4 (N=124).

Conclusion: HIVST has good HIV detection ability in men who have sex with men, and recent HIV infection cases mainly occur in
younger and more educated MSM population.
Compared to HIVFBT, HIVST is easier to reach the most at-risk populations in a timely manner and tends to detect cases
early.
Further implementation studies are needed to fill gaps in the knowledge of this model of healthcare in MSM and other target populations
.

Zhou Y, Huang S, Cui M,et al.
Comparison between HIV self-testing and facility-based HIV testing approach on HIV early detection among men who have sex with men: A cross-sectional study .
Front Immunol 2022; 13