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
Authors: Dijkstra Maartje , van Rooijen Martijn S , Hillebregt Mariska M , van Sighem Ard , Smit Colette , Hogewoning Arjan , Davidovich Udi , Heijman Titia , Hoornenborg Elske , Reiss Peter , van der Valk Marc , Prins Maria , Prins Jan M , Schim van der Loeff Maarten F , de Bree Godelieve J ,   HIV Transmission Elimination Amsterdam (H-TEAM) Initiative, van Bergen J E A M , Brokx P , Deug F , Heidenrijk M , Prins M , Reiss P , van der Valk M , van Bergen J E A M , de Bree G J , Brokx P , Davidovich U , Geerlings S E , Hoornenborg E , Oomen A , van Sighem A , Zuilhof W , Schat N , Achterbergh R C A , van Agtmael M , Ananworanich J , Van de Beek D , van den Berk G E L , Bezemer D , van Bijnen A , Blok W L , Bogers S , Bomers M , Boucher C A B , Brokking W , Burger D , Brinkman K , Brinkman N , de Bruin M , Bruisten S , Coyer L , van Crevel R , Daans C G , Dellemann L , Dijkstra M , van Duijnhoven Y T , van Eeden A , Elsenburg L , van den Elshout M A M , Ester C , Ersan E , Felipa P E V , Frissen P H J , Geijtenbeek T B H , Godfried M H , van Goo J , Goorhuis A , Groot M , Hankins C A , Heijnen A , Hillebregt M M J , Hogewoning A , Hommenga M , Hovius J W , Janssen Y , de Jong K , Jongen V , Kootstra N A , Koup R A , Kroon F P , van de Laar T J W , Lauw F , van Leeuwen M M , Lettinga K , Linde I , Loomans D S E , van der Meer J T , Mouhebati T , Mulder B J , Mulder J , Nellen F J , Nijsters A , Nobel H , Oostvogel P , Op de Coul E L M , Peters E , Peters I S , van der Poll T , Ratmann O , Rokx C , van Rooijen M S , Schim van der Loeff M F , Schoute W E M , Sonder G J , Veenstra J , Verbon A , Verdult F , de Vocht J , de Vries H J , Vrouenraets S , van Vugt M , Wiersinga W J , Wit F W , Woittiez L R , Zaheri S , Zantkuijl P , van Zelm M C , Żakowicz A , Zimmermann H M L 
Published: April 2020

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 &lt; 1 week and cART initiation in &lt; 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 &lt; 500 cells/μL (SOC); (2) January 2012–July 2015: cART initiation if CD4 &lt; 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 &lt; .001).

Conclusions
Implementing the AHI strategy was successful in diagnosing AHI and significantly decreasing the time between HIV diagnosis and viral suppression.