Knowledge of HIV status relies on accurate HIV testing, and is the first step towards access to HIV treatment and prevention programmes. Globally, HIV‐status unawareness represents a significant challenge for achieving zero new HIV infections and deaths. In order to enhance knowledge of HIV status, the World Health Organisation (WHO) recommends a testing strategy that includes the use of HIV‐specific antibody point‐of‐care tests (POCT). These POCTs do not detect acute HIV infection, the stage of disease when viral load is highest but HIV antibodies are undetectable. Complicating things further, in the presence of antiretroviral therapy (ART) for pre‐exposure prophylaxis (PrEP) or post‐exposure prophylaxis (PEP), other currently available testing technologies, such as viral load detection for diagnosis of acute HIV infection, may yield false‐negative results. In this scoping review, we evaluate the evidence and discuss alternative HIV testing algorithms that may mitigate diagnostic dilemmas in the setting of increased utilization of ART for immediate treatment and prevention of HIV infection.

中文翻译：

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暴露前预防 (PrEP)、暴露后预防 (PEP)、检测和开始以及急性 HIV 感染背景下 HIV 诊断和管理的挑战：范围审查

了解 HIV 状态依赖于准确的 HIV 检测，并且是获得 HIV 治疗和预防计划的第一步。在全球范围内，不了解 HIV 状态是实现零新增 HIV 感染和死亡的重大挑战。为了提高对 HIV 状态的了解，世界卫生组织 (WHO) 推荐了一种检测策略，其中包括使用 HIV 特异性抗体即时检测 (POCT)。这些 POCT 无法检测到急性 HIV 感染，即病毒载量最高但检测不到 HIV 抗体的疾病阶段。更复杂的是，在存在用于暴露前预防 (PrEP) 或暴露后预防 (PEP) 的抗逆转录病毒疗法 (ART) 的情况下，其他目前可用的检测技术，例如用于诊断急性 HIV 感染的病毒载量检测，可能会产生假阴性结果。在本次范围审查中，我们评估了证据并讨论了替代 HIV 检测算法，这些算法可以在增加 ART 用于立即治疗和预防 HIV 感染的情况下减轻诊断困境。