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Acute HIV infection (AHI) identification

Project Focus
HIV/AIDS; Acute HIV Infection

Project Location
Hillbrow, Johannesburg

Duration of Project
2005 – 2010

Project Partners
National Health Laboratory Services (NHLS)

Project Donors
RHRU, NHLS

Contact
Dr Jocelyn Moyes

Project Aims /Objectives
This project is an operational study to see whether it is possible to identify, recruit, interview, characterise and follow a small cohort of people with AHI.

Primary Objectives:

To assess whether we can identify, trace and contact individuals with AHI attending an inner city clinic.
To assess whether individuals with AHI are prepared to return for results, clinical assessment and risk reduction counseling.
To assess what sexual behaviors occur at the point of HIV transmission in individuals with AHI, and how these differ from other participant categories requesting HIV testing.

Secondary Objectives:

To assess whether it is possible to obtain consent for and contact recent sexual contacts of individuals with AHI.
Laboratory objectives include looking at evolving immunological and viral characteristics in local populations, and at alternative diagnostic strategies.

Laboratory Objectives:
To design appropriate testing algorithms using commercially available assays for the detection of AHI or early HIV infection in different clinical scenarios.

Secondary objectives:

To assess the feasibility of using these testing algorithms to accurately calculate the incidence of acute and recent HIV infections in our local population.
Assess the cost effectiveness of assays.
To investigate alternative assays currently being developed for HIV diagnosis and monitoring for their application to AHI identification.
Currently, the HIVRMI assay (reservoir monitoring index) {provisional patent, Wits, Lesley Scott) is an initial candidate. This new assay measures intracellular nucleic acid concentrations by flow cytometry, and may be an affordable option to plasma viral load, and diagnosis of AHI.
Maintain a well-characterized specimen storage log for future analysis on AHI, using newly developed diagnostic tests.
Assess potential trends between viral load (plasma and proviral viral genetic material) and viral genetic diversity. Data could indicate a potential relationship between virological parameters and viral set point, which correlates with the speed of clinical progression, in acute HIV infection.
Identify virus specific immune responses as they develop in the newly infected host and the effector cells of the immune response that correlate with virological controls and viral set point.
Investigate immune escape and loss of viral control, so as to identify the earliest targets of host-imposed viral genome selection, and define the impact of mutational changes that occur during viral infection on viral fitness.
Establish the presence/absence of antiretroviral drug resistant mutations in seroconverters, to determine rates of transmission of drug resistant viruses in new infections within our population.
Identify host genetic factors that impact on disease progression, (and possibly ARV treatment outcome).

Project Activities
To screen and enroll participants, to collect data during the follow up period and to monitor health status of participants.

Anticipated/Actual Results

Identify if participants with AHI are prepared to return for care if given access to their results;
Identify how participants would respond to advice regarding prevention, and whether they are prepared to bring sexual contacts forward for HIV diagnosis and care;
Understanding of the sexual behaviors at the point of transmission to help inform HIV prevention programs;
Identify people with AHI longitudinally after establishing the specific transmission event to develop understanding of the local window period for different HIV diagnostic tests and to develop new and better diagnostic testing strategies;
Further understanding of the immunological and virological evolution of the disease in these early stages in local populations, and to improve treatment.

Additional Outputs
Developed protocol

Future Plans
Further develop locally relevant programme of AHI testing, immunology and viral investigative and behavioral studies

Projects in the STI's & HIV Research Cluster:

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