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The Cost-Effectiveness of Symptom-Based Testing and Routine Screening for Acute HIV Infection in Men Who Have Sex With Men in the USA

September 7, 2011

Testing for HIV when flu-like symptoms are evident may offer a cost-effective alternative for early detection of HIV infection in men who have sex with men (MSM), reported the authors of the current study.

"Acute HIV infection often causes influenza-like illness (ILI) and is associated with high infectivity," wrote the researchers, who estimated the effectiveness and cost-effectiveness of strategies to identify and treat acute HIV infection among US MSM.

Designed as a dynamic model of HIV transmission and progression, the study evaluated three testing approaches:

The researchers included treatment with antiretroviral therapy for persons indentified as acutely infected. The main study outcomes were new HIV infections, discounted quality-adjusted life years (QALYs) and costs, and incremental cost-effectiveness ratios.

"At the present rate of HIV antibody testing, we estimated that 538,000 new infections will occur among MSM over the next 20 years," the authors wrote. They calculated that expanding antibody screening coverage to 90 percent of MSM annually would reduce new infections by 2.8 percent and cost $12,582 per QALY gained.

While more expensive than expanded antibody screening, symptom-based viral load testing with ILI is more effective, reducing new infections by 4.2 percent at a cost of $22,786 per QALY gained. Combining expanded antibody screening with symptom-based viral load testing reduced new infections by 5.7 percent at a cost of $29,923 per QALY gained. Adding viral load testing to all annual HIV antibody tests would further increase the detection rate, but at a prohibitively expensive cost of more than $100,000 per QALY gained.

"Targeted viral load testing of symptomatic MSM provides approximately 80 percent of the benefit of universal viral load testing at less than half the cost," the authors wrote. "Use of HIV viral load testing in MSM with [ILI] prevents more infections than does annual antibody screening alone and is cost-effective."

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Excerpted from:
AIDS
09.10.2011; Vol. 25; No. 14: P. 1779-1787; Jessie L. Juusola, Margaret L. Brandeau, Elisa F. Long, Douglas K. Owens, Erand Bendavid




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