Acute and early HIV infection screening among men who have sex with men, a systematic review and meta-analysis.

Autor: Palmer S; Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute, Kilifi, Kenya.; International AIDS Vaccine Initiative, Amsterdam, the Netherlands., Dijkstra M; Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands.; Department of Internal Medicine, Division of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands., Ket JC; Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands., Wahome EW; Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute, Kilifi, Kenya., Walimbwa J; ISHTAR MSM Health and Social Wellbeing, Nairobi, Kenya., Gichuru E; Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute, Kilifi, Kenya., van der Elst EM; Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute, Kilifi, Kenya., Schim van der Loeff MF; Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands.; Department of Internal Medicine, Division of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands., de Bree GJ; Department of Internal Medicine, Division of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands., Sanders EJ; Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute, Kilifi, Kenya.; Department of Global Health, and Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.; Nuffield Department of Medicine, University of Oxford, Headington, United Kingdom.
Jazyk: angličtina
Zdroj: Journal of the International AIDS Society [J Int AIDS Soc] 2020 Oct; Vol. 23 Suppl 6, pp. e25590.
DOI: 10.1002/jia2.25590
Abstrakt: Introduction: Screening for acute and early HIV infections (AEHI) among men who have sex with men (MSM) remains uncommon in sub-Saharan Africa (SSA). Yet, undiagnosed AEHI among MSM and subsequent failure to link to care are important drivers of the HIV epidemic. We conducted a systematic review and meta-analysis of AEHI yield among MSM mobilized for AEHI testing; and assessed which risk factors and/or symptoms could increase AEHI yield in MSM.
Methods: We systematically searched four databases from their inception through May 2020 for studies reporting strategies of mobilizing MSM for testing and their AEHI yield, or risk and/or symptom scores targeting AEHI screening. AEHI yield was defined as the proportion of AEHI cases among the total number of visits. Study estimates for AEHI yield were pooled using random effects models. Predictive ability of risk and/or symptom scores was expressed as the area under the receiver operator curve (AUC).
Results: Twenty-two studies were identified and included a variety of mobilization strategies (eight studies) and risk and/or symptom scores (fourteen studies). The overall pooled AEHI yield was 6.3% (95% CI, 2.1 to 12.4; I 2  = 94.9%; five studies); yield varied between studies using targeted strategies (11.1%; 95% CI, 5.9 to 17.6; I 2  = 83.8%; three studies) versus universal testing (1.6%; 95% CI, 0.8 to 2.4; two studies). The AUC of risk and/or symptom scores ranged from 0.69 to 0.89 in development study samples, and from 0.51 to 0.88 in validation study samples. AUC was the highest for scores including symptoms, such as diarrhoea, fever and fatigue. Key risk score variables were age, number of sexual partners, condomless receptive anal intercourse, sexual intercourse with a person living with HIV, a sexually transmitted infection, and illicit drug use. No studies were identified that assessed AEHI yield among MSM in SSA and risk and/or symptom scores developed among MSM in SSA lacked validation.
Conclusions: Strategies mobilizing MSM for targeted AEHI testing resulted in substantially higher AEHI yields than universal AEHI testing. Targeted AEHI testing may be optimized using risk and/or symptom scores, especially if scores include symptoms. Studies assessing AEHI yield and validation of risk and/or symptom scores among MSM in SSA are urgently needed.
(© 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.)
Databáze: MEDLINE
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