Six-Week Follow-Up After HIV-1 Exposure: A Position Statement from the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy

In 2014 the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy (RAV) conducted a review and analysis of the state of knowledge on the duration of follow-up after exposure to human immunodeficiency virus (HIV). 

Up until then a follow-up of 12 weeks after exposure had been recommended, but improved tests and new information on early diagnosis motivated a re-evaluation of the national recommendations by experts representing infectious diseases and microbiology, county medical officers, the RAV, the Public Health Agency, and other national authorities. 

Based on the current state of knowledge the Public Health Agency of Sweden and the RAV recommend, starting in April 2015, a follow-up period of 6 weeks after possible HIV-1 exposure, if HIV testing is performed using laboratory-based combination tests detecting both HIV antibody and antigen. If point-of-care rapid HIV tests are used, a follow-up period of 8 weeks is recommended, because currently available rapid tests have insufficient sensitivity for detection of HIV-1 antigen. 

A follow-up period of 12 weeks is recommended after a possible exposure forHIV-2, since presently used assays do not include HIV-2 antigens and only limited information is available on the development of HIV antibodies during early HIV-2 infection. 

If pre- or post-exposure prophylaxis is administered, the follow-up period is recommended to begin after completion of prophylaxis. Even if infection cannot be reliably excluded before the end of the recommended follow-up period, HIV testing should be performed at first contact for persons who seek such testing.

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By:   Gaines H1,2,3, Albert J4,5,6, Axelsson M1, Berglund T1, Gisslén M6,7, Sönnerborg A3,5,6,8, Blaxhult A9, Bogdanovic G5, Brytting M1, Carlander C6,10, Flamholc L6,11, Follin P12, Haggar A13, Hagstam P14, Johansson M15, Navér L6,16,17, Persson Blom J18, Samuelson A5, Ström H13, Sundqvist M19, Svedhem Johansson V3, Tegmark Wisell K1, Tegnell A1, Thorstensson R1.

• 1 Public Health Agency of Sweden , Solna .
• 2 Unit of Infectious Diseases, Department of Medicine , Karolinska Institutet , Stockholm .
• 3 Department of Infectious Diseases , Karolinska University Hospital , Stockholm .
• 4 Department of Microbiology , Tumor and Cell Biology, Karolinska Institutet , Stockholm .
• 5 Department of Clinical Microbiology , Karolinska University Hospital , Stockholm .
• 6 Swedish Reference Group for Antiviral Therapy , Stockholm .
• 7 Department of Infectious Diseases , Sahlgrenska Academy, University of Gothenburg , Gothenburg .
• 8 Department of Laboratory Medicine, Division of Clinical Microbiology , Karolinska Institutet , Stockholm .
• 9 Department of Infectious Diseases , Södersjukhuset Venhälsan , Stockholm .
• 10 Clinic of Infectious Diseases, County Hospital of Västmanland , Västerås .
• 11 Department of Infectious Diseases , University of Lund, Skåne University Hospital , Malmö .
• 12 Department of Communicable Disease Control and Prevention , Region Västra Götaland , Gothenburg .
• 13 National Board of Health and Welfare , Stockholm .
• 14 Department of Communicable Disease Control and Prevention , Skåne , Malmö .
• 15 Department of Clinical Microbiology and Infectious Diseases , Kalmar County Hospital , Kalmar .
• 16 Department of Pediatrics , Karolinska University Hospital , Stockholm .
• 17 Department of Clinical Science , Intervention and Technology, Karolinska Institute , Stockholm .
• 18 Swedish Work Environment Authority , Stockholm , and.
• 19 Department of Laboratory Medicine , Clinical Microbiology, Örebro University Hospital , Örebro , Sweden. 

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