[Three-Year Multicenter Analysis of HIV Infection Diagnostic Data]

Area of Science:

• Clinical Medicine
• Infectious Diseases
• Public Health

Background:

• Türkiye adopted the updated three-step human immunodeficiency virus (HIV) testing algorithm in 2019, aligning with CDC guidelines.
• The study addresses the need to understand the current landscape of HIV diagnosis in Türkiye.

Purpose of the Study:

• To evaluate the performance of the current HIV testing algorithm in Türkiye.
• To identify challenges and propose solutions for HIV diagnosis.
• To assess the impact of the updated algorithm and external factors like the COVID-19 pandemic on HIV testing practices.

Main Methods:

• A multicenter, multidisciplinary approach was used, surveying 12 HIV testing centers with a 57-question survey.
• Data from 2018-2020 included HIV enzyme-linked immunosorbent assay (ELISA) tests, reactive rates, confirmatory test results, and HIV nucleic acid amplification tests (NAT).
• Analysis focused on trends in Western Blot (WB) utilization versus HIV-1/2 antibody differential rapid tests and HIV-1 RNA testing.

Main Results:

• Between 2018-2020, anti-HIV ELISA tests showed stable confirmed HIV rates (0.21-0.25%) with a slight increase in repeat reactivity (0.48-0.70%).
• Western Blot (WB) utilization decreased significantly (25.77% to 9.86%), while HIV-1/2 antibody differential rapid tests increased (25.72% to 45.78%), indicating a shift in confirmatory methods.
• HIV-1 NAT utilization saw a significant decrease in 2020 (46.31%) compared to 2019 (97.98%), attributed to resource reallocation towards COVID-19 testing.

Conclusions:

• The rapid HIV-1/2 antibody differential test is increasingly effective in HIV diagnosis in Türkiye.
• The decline in HIV-1 NAT use, potentially linked to the COVID-19 pandemic, necessitates close monitoring of the HIV epidemic.
• Further investigation is needed to understand the long-term implications of these shifts in testing algorithms and resource allocation.