Candidate for the Lee B. Lusted Student Prize Competition
Purpose: Acute HIV infection often causes influenza-like illness (ILI) and is associated with high infectivity. Antiretroviral therapy (ART) substantially decreases infectivity and could reduce transmission if people with acute HIV infection could be identified promptly. We estimated the effectiveness and cost-effectiveness of strategies to identify and treat acute HIV infection in men who have sex with men (MSM) in the US.
Method: We developed a dynamic model of the HIV epidemic among MSM aged 13-64 in the US. We estimated the number of new infections, quality-adjusted life-years (QALYs), and costs for three testing approaches: viral load (VL) testing for individuals with ILI, expanded screening with antibody testing, and expanded screening with antibody and VL testing. We included treatment with ART for individuals identified as acutely infected.
Result: At the present rate of HIV-antibody testing, we estimated that 538,000 new infections will occur among MSM over the next 20 years. Expanding antibody screening coverage to 90% of MSM annually reduces new infections by 2.8% and costs $12,582 per QALY gained. Symptom-based VL testing is more expensive than expanded annual antibody testing, but is more effective and costs $22,786 per QALY gained. Combining expanded annual antibody screening with symptom-based VL testing prevents twice as many infections compared to expanded antibody screening alone, at a cost of $29,923 per QALY gained. Adding VL testing to all annual HIV antibody tests costs more than $100,000 per QALY gained.
Conclusion: Among MSM, use of HIV VL testing in persons with ILI prevents more infections than does expansion of annual antibody screening alone and is inexpensive relative to other screening interventions. Clinicians should consider VL testing in MSM with ILI, in addition to encouraging annual HIV antibody screening.