Evaluation of molecular biology technology for plasma viremia detection to the identification and incorporation of patients at acute phase of HIV-1 infection

Abstract

Different mathematical models suggest that the universal treatment of HIV-1 antiretroviral drugs can lead to the control and eventual elimination of the AIDS epidemic. Increasing the HIV infection diagnosis is the first step to control the epidemic. It is the first 90 of the bold goal of UNAIDS 90-90-90, which, if we diagnose 90% of the infected population, treat 90% of these and achieve viral suppression in 90%, we will reduce the annual number of new HIV infections in more than 75%, to 500,000 in 2020 and 200,000 in 2030, ending the epidemic. Even if this goal is unrealistic, each prevented infection is justified economically, as illustrated by the CDC in 2011, which estimated that efforts to prevent 350,000 HIV infections from 1991 to 2006 in the United States resulted in savings in health spending of $ 125 billion. In Brazil, despite access to free treatment with combination antiretroviral therapy since the late nineties and a universal treatment policy since 2013, associated with reports of high rate of suppression of plasma viremia among treated patients, the epidemic numbers in country are against the global trend of the epidemic control, with an increase in the estimated number of infections (UNAIDS, 2016). At this time of the epidemic, where patients with chronic infection in treatment may be less efficient transmitters, we may assume that acute patients assume an even greater importance in the transmission. Diagnostic opportunities may been missed, including at testing and counseling centers, since serological testing, most often based on fast diagnostic tests, can be carried out in the window period, during which anti-HIV antibodies are not detected. Different studies suggest that patients in the acute phase of the disease contribute significantly to transmission and are often undiagnosed. Thus, detection of viremia may represent the possibility of diagnosis in a period of greater transmissivity. The aim of this study is to evaluate the use of viral load technology, which quantifies the plasma viremia to monitor the response to antiretroviral therapy as part of the diagnostic armamentarium of HIV-1, it allows even to identify acute cases, even when still seronegative or indeterminate. The study will be developed based on the experience gained in a pilot initiative, held in Santo André in partnership with the Adolfo Lutz Institute in recent years. In this proposal we still evaluating the feasibility of the use of a new viral load measurement technology with point-of-care characteristics similar to innovative product in use successfully by the Tuberculosis network which will be evaluated in parallel the methodology already available and validated in the Brazilian HIV-1 viral load network, expanding the assessment to other area of the ABC, as São Bernardo do Campo and São Caetano do Sul. Besides the use of viral load of HIV-1 to cases with clinical and epidemiological evidence of acute infection in individual samples, the methodology will be further evaluated for use in pool of samples and can result in considerable reduction of cost and help to reach out other individuals, such as those with symptoms of acute viral infection that seek health network with suspected dengue or other arboviruses. The proposal aims to evaluate these methodologies as part of the diagnosis tools of HIV infection, contributing to the understanding of epidemic dynamics and assisting in controlling the HIV / AIDS epidemic. (AU)