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Serological testing algorithm shows rising HIV incidence in a UK cohort of men who have sex with men: 10 years application

Fisher, Martina; Pao, Davida; Murphy, Garyc; Dean, Gilliana; McElborough, Denisb; Homer, Garyb; Parry, John Vc

doi: 10.1097/QAD.0b013e3282ef9fed
Clinical Science

Objectives: To investigate whether combining clinical data with the serological testing algorithm for recent HIV seroconversion (STARHS) reliably identifies otherwise unrecognized recent infections and observe their trends.

Design: Incorporation of STARHS into routine HIV diagnosis.

Methods: STARHS was applied to serum collected between 1996 and 2005 at HIV diagnosis and routine clinical/laboratory markers of recent infections were determined. The recent infections were identified by conventional means, by STARHS, and by both combined.

Results: Of 1526 infections diagnosed, 812 were new. Of these, 604 were in men who have sex with men (MSM); 208 in heterosexuals; 88% had serum available for STARHS, which identified 88 incident infections that would otherwise have been unrecognized (12% of all new infections, 34% of all recent infections). Of these, 88% reported recent high-risk sex; 47% reported seroconversion symptoms. STARHS confirmed recent infections in 71 of 74 (96%) known to be infected within 6 months by conventional methods. Combining both approaches, recent infections increased over time from 26% (1996) to 45% (2005) [P < 0.001]. STARHS results from 3% new diagnoses and 8% previous diagnoses were deemed false incident (associated with antiretroviral therapy, advanced disease or undetectable viral load). False incident results were only inexplicable in two individuals.

Conclusion: Adjunctive use of STARHS with clinical data identified a high and increasing proportion of new HIV diagnoses as recent infections, confirming significant ongoing transmission. Since 2002, 50% of new diagnoses among MSM were recent infections. Identification of additional recent infections by STARHS enables effective intervention that may benefit the individual and reduce onward transmission.

From the aDepartment of HIV and Genitourinary Medicine, UK

bDepartment of Virology, Brighton and Sussex University Hospitals, Brighton, Sussex, UK

cVirus Reference Department Centre for Infections, Health Protection Agency (HPA), London, UK.

Received 6 February, 2007

Revised 19 June, 2007

Accepted 21 June, 2007

Correspondence to Martin Fisher, Department of HIV and Genitourinary Medicine, Brighton and Sussex University Hospitals, Eastern Road, Brighton, BN2 5BE, UK. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.