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Objectives HIV rapid antibody tests are widely used in Africa, but dual testing sometimes produces discordant results. It is not clear if discordant rapid HIV tests should always heighten suspicion by frontline health workers that early HIV infection is present. Some studies have reported that discordant rapid tests have value for identifying early HIV infection in high HIV prevalence populations. It is not known if rapid test performance influenced this conclusion, or if this observation will hold true for low HIV prevalence populations. We therefore explored the occurrence of discordant rapid HIV tests in a low-resource community. Methods A cross-sectional sample of HIV status-unaware adults with recent exposure to unsafe sex was assessed using a validated risk-based tool (University of North Carolina (UNC)-Malawi Risk Screening Score) for acute HIV infection. Participants received rapid testing with Determine™ HIV 1/2 and Uni-Gold™ HIV assays, plus plasma HIV-1 antigen testing with the COBAS® Ampliprep/ COBAS® Taqman® HIV-1 assay, followed by western blot in those with detected HIV-1 antigen. Results Of 408 participants, 1.0% were confirmed to have established HIV infection. The discordance between rapid tests at initial screening was 2.45 and 2.94% when the two assays were used sequentially and simultaneously, respectively. Discordant rapid tests were strongly associated with risk scores > 2 [odds ratio ( OR) 10.88; 95% confidence interval ( CI) 2.35-50.43], and with detected HIV-1 RNA ( OR 26.06; 95% CI 3.91-173.60). Conclusions When the sample occurrence of discordance between the first and second tests is below 5%, discordant rapid tests in an adult with sexual risk behaviour should trigger strong suspicion of early HIV infection in low HIV prevalence populations. [ABSTRACT FROM AUTHOR]

Pharmacologic treatment of HIV infection involves the combination of drugs that exert their antiretroviral effects at different stages in the life-cycle of the virus. Strongpublic-health programs are necessary for HIV control. To be successful in treating HIV, the clinician must establish a treatment alliance with the patient to forge optimal adherence to the treatment regimen. Potential adverse reactions,toxicities and drug-drug interactions must be understood and detected early. Disparity exists in the treatment of HIV between most African and western countries and can be bridged through improved access to drugs and treatment infrastructure. The search for a cure is led by ongoing research in novel concepts such as structured treatment intervention and immune-based therapy.