Monitoring recently acquired HIV infections in the European context

Literature review Technical report

Tests to differentiate recent from long-standing infections – known as Recent Infection Testing Algorithms (RITA) – have become an increasingly attractive approach to monitoring recent HIV infections and are used for estimating HIV incidence in several countries.
This literature review provides a range of estimates in key populations, highlighting studies that have employed a RITA assay to distinct populations in order to produce estimates of HIV incidence, and pays particular attention to variations in assays, settings, window periods, and methods of analysis.
Estimates of HIV incidence across populations most at risk were generally below 1–2% per year, and below 4% per year among attendees of STI clinics and similar high-risk settings. Estimated HIV incidence rates among men who have sex with men were generally less than 5% per year, similar to those reported among migrant populations and ethnic minorities.

Executive summary

A better understanding of current transmission of HIV is important to direct HIV prevention interventions. This report describes studies on HIV incidence estimates in European countries. The report contains the results of a literature review of published incidence studies using Recent Infection Testing Algorithms (RITA) assays, an epidemiological framework for HIV incidence studies in Europe and a technical guide on how to integrate RITA as part of routine HIV surveillance. According to the report, estimates of HIV incidence across populations most at risk were generally between 1–2% per year, and below 4% per year among attendees of STI clinics and similar high-risk settings. Estimated HIV incidence rates among men who have sex with men were generally around 5% per year, similar to those reported among migrant populations and ethnic minorities.  

RITA testing

RITA tests to differentiate recent from long-standing infections have become an increasingly important approach to monitoring recently acquired HIV infections and are used for estimating HIV incidence in several countries. This literature review provides a range of estimates in key populations, highlighting studies that have employed a RITA assay to distinct populations in order to produce estimates of HIV incidence, and pays particular attention to variations in assays, settings, window periods, and methods of analysis. This offers the potential to coordinate and strengthen HIV incidence surveillance activities and provide insights into current transmission patterns and dynamics of the infection within subpopulations across Europe. In addition, these data will guide HIV prevention and intervention strategies, including earlier HIV testing.