Screening for Acute HIV Infection in Fortaleza, Brazil: What Would Be the Best Strategy?

Brazil is considered a middle-income country, where human immunodeficiency virus (HIV) transmission and morbidity/mortality indicators have shown relative stability. The Northeast region of the country has less favorable socioeconomic indicators, with an increase in these statistics. In this context, the diagnosis of acute HIV infection (AHI) can favor the improvement of the control of the disease. This study aimed to evaluate the effectiveness of universal screening for AHI in users of serological screening services, seeking to determine factors associated with the diagnosis of HIV infection. From July 2017 to July 2018, users of the voluntary counseling and testing center (VCT) of Fortaleza, with a minimum age of 18?years and with negative or indeterminate results in the rapid test for HIV, were invited to undergo the nucleic acid amplification test (NAAT). During the study, 7,166 users were enrolled, and 6,943 underwent rapid HIV testing, with 344 reactive results (5.0%). Factors associated with the diagnosis of HIV infection were male (prevalence ratio [PR]=22.3; 95% confidence interval [CI] 14.6?35.1), first visit the VCT (PR = 28.0; 95% CI: 20.4?39.3), recent sexually transmitted infection (STI) (PR = 13.8; 95% CI: 10.5?18.0), more than two recent sexual partners (PR = 14.4; 95% CI: 10.4?20.1), homosexual (PR = 33.4; 95% CI: 24.4?46.2) or bisexual (PR = 22.0; 95% CI: 12.6?36.7) practices, and reactive results for syphilis (PR = 16.4; 95% CI: 11.9?22.7). Among the 6,599 individuals with an indeterminate or nonreactive rapid test for HIV, 334 (5.1%) were selected for NAAT, and no cases of AHI were identified. The universal testing strategy by NAAT was not effective in screening for AHI, suggesting the need for targeted screening. Factors associated with the diagnosis of established HIV infection, such as men who have sex with men, recent STI, first visit to the service, number of partners (>two per year), and reactive test for syphilis, are potential targeting criteria.