Improving the evidence for indicator condition guided HIV testing in Europe: Results from the HIDES II Study - 2012 - 2015

PLoS One. 2019 Aug 13;14(8):e0220108. doi: 10.1371/journal.pone.0220108. eCollection 2019.

Abstract

Background: It is cost-effective to perform an HIV test in people with specific indicator conditions (IC) with an undiagnosed HIV prevalence of at least 0.1%. Our aim was to determine the HIV prevalence for 14 different conditions across 20 European countries.

Methods: Individuals aged 18-65 years presenting for care with one of 14 ICs between January 2012 and June 2014 were included and routinely offered an HIV test. Logistic regression assessed factors associated with testing HIV positive. Patients presenting with infectious mononucleosis-like syndrome (IMS) were recruited up until September 2015.

Results: Of 10,877 patients presenting with an IC and included in the analysis, 303 tested positive (2.8%; 95% CI 2.5-3.1%). People presenting with an IC in Southern and Eastern Europe were more likely to test HIV positive as were people presenting with IMS, lymphadenopathy and leukocytopenia/ thrombocytopenia. One third of people diagnosed with HIV after presenting with IMS reported a negative HIV test in the preceding 12 months. Of patients newly diagnosed with HIV where data was available, 92.6% were promptly linked to care; of these 10.4% were reported lost to follow up or dead 12 months after diagnosis.

Conclusion: The study showed that 10 conditions had HIV prevalences > 0.1%. These 10 ICs should be adopted into HIV testing and IC specialty guidelines. As IMS presentation can mimic acute HIV sero-conversion and has the highest positivity rate, this IC in particular affords opportunities for earlier diagnosis and public health benefit.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Early Diagnosis*
  • Europe, Eastern / epidemiology
  • Female
  • HIV / isolation & purification*
  • HIV Infections / diagnosis*
  • HIV Infections / epidemiology
  • HIV Infections / virology
  • Humans
  • Male
  • Mass Screening*
  • Middle Aged
  • Patient Acceptance of Health Care
  • Prevalence
  • Serologic Tests / methods*
  • Young Adult

Grants and funding

The HIDES study was funded by the HIV in Europe initiative which has received unrestricted funding from Gilead Sciences, ViiV Healthcare, Merck, Tibotec, Pfizer, Schering-Plough, Abbott, Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, and the European Commission under the 2nd Health Programme. The study is also supported by a grant [grant number DNRF126] from the Danish National Research Foundation. The operational procedures within the initiative include the following to maintain the autonomy of the initiative. The Steering Committee is the governing body and sponsors do not have representation on the Steering Committee. Furthermore, data, records, reports, Intellectual Property Rights and Know How generated as result of the initiative shall be deemed vested in and the property of the Steering Committee. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.