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Routine laboratory screening for acute and recent HIV infection in Lima, Peru
  1. Jesse L Clark1,
  2. Eddy R Segura2,
  3. Silvia M Montano3,
  4. Segundo R Leon2,
  5. Tadeusz Kochel3,
  6. Hector J Salvatierra2,4,
  7. Jorge Alcantara4,
  8. Carlos F Cáceres2,
  9. Thomas J Coates1,
  10. Jeffrey D Klausner5
  1. 1David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  2. 2Universidad Peruana Cayetano Heredia, Lima, Peru
  3. 3US Naval Medical Research Center Detachment, Lima, Peru
  4. 4Dirección de Salud I-Callao, Ministerio de Salud, Lima-Callao, Peru
  5. 5San Francisco Department of Public Health, San Francisco, California, USA
  1. Correspondence to Dr Jesse L Clark, Department of Medicine, Division of Infectious Diseases and Program in Global Health, David Geffen School of Medicine at UCLA, 10833 Leconte Ave, CHS 37-121, Los Angeles, CA 90095, USA; jlclark{at}mednet.ucla.edu

Abstract

Background Before implementing screening programmes for acute HIV infection in developing countries, key issues, including cost, feasibility and public health impact, must be determined.

Objective Fourth-generation enzyme immunoassay (EIA) was compared with HIV-1 RNA PCR for the detection of acute and early HIV infection in counselling and testing populations in Lima, Peru.

Methods Adults presenting for HIV testing at designated clinics in Lima-Callao, Peru were offered additional screening for acute HIV infection. All serum samples were tested with fourth-generation Ag/Ab EIA and confirmed by line immunoassay. Negative specimens were combined into 50-sample pools for HIV-1 RNA screening by PCR analysis in standard pooling algorithms. RNA-positive samples were retested with a third-generation EIA to evaluate the relative sensitivity of standard testing procedures.

Results Between 2007 and 2008 1191 participants were recruited. The prevalence of HIV infection was 3.2% (38/1191; 95% CI 2.2% to 4.2%) overall and 10.5% (25/237; 95% CI 6.6% to 14.5%) among men who reported sex with men (MSM). The prevalence of acute or recent HIV infection was 0.2% (95% CI 0% to 0.4%) overall and 0.8% (95% CI 0% to 2.0%) among MSM. Compared with third-generation EIA testing, both fourth-generation EIA and RNA PCR increased the rate of HIV case identification by 5.3% overall and by 8.0% within the subpopulation of MSM.

Conclusions Screening for acute HIV infection within Peru's resource-limited public health system was acceptable and detected a high prevalence of acute and recent HIV infection among MSM. Additional efforts are needed to screen for, and prevent, transmission of HIV among MSM in Peru during the acute seroconversion stage.

  • Acute HIV infection
  • pooled RNA testing
  • Peru: men who have sex with men
  • HIV testing
  • homosexuality
  • PCR
  • STD surveillance

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Footnotes

  • Parts of the data reported were previously presented at the International Society for STD Research Meeting (London, UK; June, 2009).

  • Funding JLC was previously supported by NIH T32 MH080634 and is currently supported by NIH K23 MH084611. Additional support was provided by the UCLA AIDS Institute/Center for AIDS Research. Disclaimer: The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the US Government. LCDR TK is a military service member and SM is an employee of the US Government. This work was prepared as part of their official duties. Title 17 U.S.C. § 105 provides that ‘Copyright protection under this title is not available for any work of the United States government’. Title 17 U.S.C. § 101 defines a US Government work as a work prepared by a military service member or employee of the US Government as part of that person's official duties.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of California, Los Angeles Universidad Peruana Cayetano Heredia US Naval Medical Research Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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