Serological testing algorithm shows rising HIV incidence in a UK cohort of men who have sex with men: 10 years application

AIDS. 2007 Nov 12;21(17):2309-14. doi: 10.1097/QAD.0b013e3282ef9fed.


Objectives: To investigate whether combining clinical data with the serological testing algorithm for recent HIV seroconversion (STARHS) reliably identifies otherwise unrecognized recent infections and observe their trends.

Design: Incorporation of STARHS into routine HIV diagnosis.

Methods: STARHS was applied to serum collected between 1996 and 2005 at HIV diagnosis and routine clinical/laboratory markers of recent infections were determined. The recent infections were identified by conventional means, by STARHS, and by both combined.

Results: Of 1526 infections diagnosed, 812 were new. Of these, 604 were in men who have sex with men (MSM); 208 in heterosexuals; 88% had serum available for STARHS, which identified 88 incident infections that would otherwise have been unrecognized (12% of all new infections, 34% of all recent infections). Of these, 88% reported recent high-risk sex; 47% reported seroconversion symptoms. STARHS confirmed recent infections in 71 of 74 (96%) known to be infected within 6 months by conventional methods. Combining both approaches, recent infections increased over time from 26% (1996) to 45% (2005) [P < 0.001]. STARHS results from 3% new diagnoses and 8% previous diagnoses were deemed false incident (associated with antiretroviral therapy, advanced disease or undetectable viral load). False incident results were only inexplicable in two individuals.

Conclusion: Adjunctive use of STARHS with clinical data identified a high and increasing proportion of new HIV diagnoses as recent infections, confirming significant ongoing transmission. Since 2002, 50% of new diagnoses among MSM were recent infections. Identification of additional recent infections by STARHS enables effective intervention that may benefit the individual and reduce onward transmission.

MeSH terms

  • AIDS Serodiagnosis / methods*
  • Acute Disease
  • Algorithms*
  • HIV Infections / epidemiology
  • HIV Infections / transmission
  • HIV Seropositivity / epidemiology*
  • HIV*
  • Homosexuality, Male*
  • Humans
  • Incidence
  • Male
  • United Kingdom / epidemiology
  • Unsafe Sex