Eur J Microbiol Immunol (Bp) doi.org/10.1556/1886.2018.00007

Diagnostics as Prevention — A Rapid Testing-Based Strategy of Sex Workers against Sexual HIV Exposure

Hahn A, Hinz R, Meyer T, Loderstädt U, Herchenröder O, Meyer CG, Schwarz NG, Frickmann H.
Introduction: German sex workers have illegally established a prevention strategy, which consists of testing potential
sexual partners with human immunodeficiency virus (HIV)-specific rapid diagnostic tests (RDTs) prior to engaging in
unprotected sexual intercourse eventually performed in case of a negative test result. Based on a recently established
modeling approach, the effectiveness of this strategy regarding the risk of HIV exposure was compared with protection
provided by condom use.
Methods: Based on a literature search, the following assumptions were used for the calculations: an averaged 80%
exposure risk reduction with a condom used during sexual intercourse, usage of a well-characterized 4th-generation
HIV RDT, and a 10 day post-infection period without any measurable viral load in peripheral blood followed by a seroconversion
period of about 3 weeks with 12.3% test sensitivity (antigen-specific) and only afterwards 97.3% (antibodyspecific)
test sensitivity.
Results: In most constellations, the HIV exposure risk in case of RDT-based prevention was lower than with condom use.
Conclusions: The RDT-based HIV exposure prevention as established by sex workers is effective in most situations.
A notable weakness of the strategy is the RDTs' poor sensitivity in spite of a high transmission risk during
the seroconversion stage.
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