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Factors associated with acute HIV infection diagnosis in MSM ANRS-Opportunity study

Factors associated with acute HIV infection diagnosis in MSM ANRS-Opportunity study. Karen Champenois , Stéphane Le Vu, Lise Cuzin , Caroline Semaille , Yazdan Yazdanpanah Inserm U738, équipe ATIP-Avenir, Paris, France MOAC0103. Relevance of HIV testing.

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Factors associated with acute HIV infection diagnosis in MSM ANRS-Opportunity study

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  1. Factors associated with acute HIV infection diagnosis in MSMANRS-Opportunity study Karen Champenois, Stéphane Le Vu, Lise Cuzin, Caroline Semaille, Yazdan Yazdanpanah Inserm U738, équipe ATIP-Avenir, Paris, France MOAC0103

  2. Relevance of HIV testing “Whatever … scientifically proven HIV treatment or prevention strategies (PreP / TasP) they will share a common denominator for implementation: the HIV test. They all begin with learning one’s HIV status.”

  3. Unawareness of HIV infection in France Supervie et al. HIV in Europe Conference 2012, Copenhaguen

  4. Unawareness of HIV infection in France and transmission of HIV (adaptedfrom Marks et al. AIDS 2006, with French estimated data) Supervie et al. HIV in Europe Conference 2012, Copenhaguen

  5. HIV transmission riskaccording to the stages of HIV disease and viral load Galvin et al., Nat RevMicrobiol, 2004

  6. Objective To identify factors associated with diagnosis at acute HIV infection stage in MSM in France

  7. Source of data The ANRS – Opportunitystudy • Objective: Identify missed opportunities for HIV testing • within healthcare settings encounters • in patients with newly diagnosed HIV infection HIV diagnosis 3 years Champenois et al. BMC Infect Dis 2013 7

  8. ANRS – Opportunitystudy,methods • Universityhospital • Non universityhospital Study design • Cross-sectionalstudy • 69 HIV care centers • 06/2009 - 10/2010 • Administred questionnaire Study population • Age ≥18 years • Living in France for ≥1 year • Newly HIV diagnosed infections (≤6 months of care initiation) • HIV diagnosis in France 8

  9. The ANRS – Opportunitystudy population (n=1,008) *Cazein et al. BEH 2011

  10. HIV-infection stage atdiagnosisamong 530 MSM enrolled in the Opportunitystudy • incomplete western blot • or Agp24+ or RNA+ with EIA- • or last negative test <3 months • EIA+ or last negtest >3 mo • CD4 cell counts >200/µL • no AIDS • EIA+ or last negtest >3 mo • CD4 cell counts ≤200/µL • or AIDS

  11. Comparison of MSM diagnosedat acute stage vs. chronic stage  Multivariatelogisticregression model

  12. Demographiccharacteristics Values do not sum to 297 and/or 111 because of missing data

  13. Sexual behaviour Values do not sum to 297 and/or 111 because of missing data; NA: not available

  14. Whointiated the test leading to HIV diagnosis? % *Others: relatives, friends, NGOs, etc…

  15. History of HIV testing Variable created to combine the history of HIV testing and the number of test in the 3 yearsprior to HIV diagnosis: No. tests in the 3 previousyears / history of testing

  16. History of HIV testing • Variable created to combine the history of HIV testing and the number of test in the 3 yearsprior to HIV diagnosis: • Testednever or rarely: 0 test lifetime or >3 years ago No. tests in the 3 previousyears / history of testing

  17. History of HIV testing • Variable created to combine the history of HIV testing and the number of test in the 3 yearsprior to HIV diagnosis: • Testednever or rarely: 0 test lifetime or >3 years ago • Tested occasionally: >1 test 1 to 3 years ago No. tests in the 3 previousyears / history of testing

  18. History of HIV testing • Variable created to combine the history of HIV testing and the number of test in the 3 yearsprior to HIV diagnosis: • Testednever or rarely: 0 test lifetime or >3 years ago • Tested occasionally: >1 test 1 to 3 years ago • Tested regularly: tested ≤1 year and 1-3 tests No. tests in the 3 previousyears / history of testing

  19. History of HIV testing • Variable created to combine the history of HIV testing and the number of test in the 3 yearsprior to HIV diagnosis: • Testednever or rarely: 0 test lifetime or >3 years ago • Tested occasionally: >1 test 1 to 3 years ago • Tested regularly: tested ≤1 year and 1-3 tests • Testing very frequently: tested ≤1 year and >3 tests No. tests in the 3 previousyears / history of testing

  20. History of HIV testing

  21. Factors associated with HIV diagnosis at acute stage (multivariate analysis) *Others: relatives, friends, NGOs, etc…

  22. Discussion Diagnosis at acute HIV infection stage is associated with • HIV–test initiated by healthcare providers • 42% of patients diagnosed in acute stage vs. 29% of those diagnosed in chronic stage  Inform and train healthcare providers to • Symptoms related to HIV infection • HIV testing: systematic offer, regular offer for HIV exposed population • Acute infection: HIV RNA measure rather than EIA test Champenoiset al. BMC Infect Dis 2013; Yazdanpanah at al. Plos One 2010

  23. Discussion Diagnosisat acute HIV infection stage isassociatedwith • History of testing: recent and frequent • Promotedifferent HIV testingstrategies • Care provider-based HIV testing • Community-basedVCT • Out-reachrapidtesting in sex venues • … Champenois et al. BMJ Open 2012; Greacen et al. AIDS Care 2012

  24. Discussion • Strengths and limitations • Enrollment of 1/5 MSM newly HIV diagnosed in France • Results extrapolated to MSM who live in France • Study not designed especially for MSM and had another main objective • Sexual behaviour could not be studied in detail

  25. Conclusions • 21% of MSM were diagnosed at acute HIV-infection stage How to improve early HIV testing in MSM? • Promote HIV–test initiated by healthcare providers • Improve knowledge and training • Promote repeated testing in MSM • Recommendations of >1 test / year • Extend HIV-testing offers • Complementarity strategies

  26. Acknowledgments • Financial support: ANRS, InVS • Healthcare providers and patients whocollaborated / participated to the ANRS - Opportunitystudy

  27. Estimation of HIV infection incidence in France by transmission group Femmes hétérosexuelles françaises Hommes hétérosexuels français Nombre de nouvelles infections à VIH Hommes qui ont des rapports sexuels avec des hommes Femmes hétérosexuelles étrangères Hommes hétérosexuels étrangers Usagers de drogues injectables MSM • MSM • Incidence 60-fold higherthanoverall population • 31% of the hiddenepidemic (~9,000 / 29,000) Années Ndawinzet al. AIDS 2011; Le Vu et al. Lancet Infect Dis 2010

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