Decreased time to viral suppression after implementation of targeted testing and immediate initiation of treatment of acute HIV infection among men who have sex with men in Amsterdam.

BACKGROUND: Men who have sex with men (MSM) with acute HIV infection (AHI) are a key source of new infections. To curb transmission we implemented in August 2015 a strategy for rapid diagnosis of AHI 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 1,013 MSM were diagnosed at the Amsterdam STI clinic. Standard of care (SOC) included HIV diagnosis confirmation in <1 week and cART initiation in <1 month. The AHI strategy comprised same-visit HIV diagnosis confirmation and immediate cART initiation. AHI diagnoses were assessed before and after implementation of the AHI strategy. Time from diagnosis to viral suppression was assessed for three cART initiation periods: (1) 2008-2011: cART initiation if CD4<500 cells/mm3 (SOC); (2) January 2012-July 2015: cART initiation if CD4<500 cells/mm3, or if AHI or early HIV infection (SOC); (3a) August 2015-June 2017: universal cART initiation (SOC); and (3b) August 2015-June 2017: the AHI strategy. RESULTS: Before implementation of the AHI strategy, the proportion of AHI of HIV diagnoses was 0.6% (5/876); after implementation this was 11.0% (15/137). Median time from diagnosis to viral suppression during period 1, 2, 3a, and 3b was 584 (IQR, 267-1065), 230 (IQR, 132-480), 95 (IQR, 63-136), and 55 (IQR, 31-72) days, respectively (p<0.001). CONCLUSIONS: Implementing the AHI strategy was successful in diagnosing AHI and significantly decreasing the time between HIV diagnosis and viral suppression.