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In order to enhance knowledge of HIV status, the World Health Organisation (WHO) recommends a testing strategy that includes the use of HIV\u2010specific antibody point\u2010of\u2010care tests (POCT). These POCTs do not detect acute HIV infection, the stage of disease when viral load is highest but HIV antibodies are undetectable. Complicating things further, in the presence of antiretroviral therapy (ART) for pre\u2010exposure prophylaxis (PrEP) or post\u2010exposure prophylaxis (PEP), other currently available testing technologies, such as viral load detection for diagnosis of acute HIV infection, may yield false\u2010negative results. In this scoping review, we evaluate the evidence and discuss alternative HIV testing algorithms that may mitigate diagnostic dilemmas in the setting of increased utilization of ART for immediate treatment and prevention of HIV infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Missed acute HIV infection prevents people living with HIV (PLHIV) from accessing early treatment, increases likelihood of onward transmission, and allows for inappropriate initiation or continuation of PrEP, which may result in HIV drug resistance. While immediate ART is recommended for all PLHIV, studies have shown that starting ART in the setting of acute HIV infection may result in a delayed or complete absence of development of HIV\u2010specific antibodies, posing a diagnostic challenge that is particularly pertinent to resource\u2010limited, high HIV burden settings where HIV\u2010antibody POCTs are standard of care. Similarly, ART used as PrEP or PEP may supress HIV RNA viral load, complicating current HIV testing algorithms in resource\u2010wealthy settings where viral detection is included. As rollout of PrEP continues, HIV testing algorithms may need to be modified.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>With increasing use of PrEP and ART in acute infection we anticipate diagnostic challenges using currently available HIV testing strategies. Research and surveillance are needed to determine the most appropriate assays and optimal testing algorithms that are accurate, affordable and sustainable.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25419","type":"journal-article","created":{"date-parts":[[2019,12,18]],"date-time":"2019-12-18T11:34:21Z","timestamp":1576668861000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":90,"title":["Challenges of HIV diagnosis and management in the context of pre\u2010exposure prophylaxis (PrEP), post\u2010exposure prophylaxis (PEP), test and start and acute HIV infection: a scoping review"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8232-9413","authenticated-orcid":false,"given":"Tamara","family":"Elliott","sequence":"first","affiliation":[{"name":"Imperial College London London United Kingdom"},{"name":"Imperial College Healthcare NHS Trust London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduard J","family":"Sanders","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute\u2010Wellcome Trust Research Programme Kilifi Kenya"},{"name":"Nuffield Department of Medicine University of Oxford Oxford United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meg","family":"Doherty","sequence":"additional","affiliation":[{"name":"Department of HIV and Global Hepatitis Programme WHO Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thumbi","family":"Ndung'u","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute Durban South Africa"},{"name":"HIV Pathogenesis Programme Doris Duke Medical Research Institute University of KwaZulu\u2010Natal Durban South Africa"},{"name":"The Ragon Institute of Massachusetts General Hospital Massachusetts Institute of Technology and Harvard University Cambridge MA USA"},{"name":"Max Planck Institute for Infection Biology Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5917-9664","authenticated-orcid":false,"given":"Myron","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Infectious Diseases UNC School of Medicine University of North Carolina At Chapel Hill Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pragna","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB Centers for Disease Control and Prevention Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gus","family":"Cairns","sequence":"additional","affiliation":[{"name":"NAM Aidsmap London United Kingdom"},{"name":"PrEP in Europe Initiative London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah E","family":"Rutstein","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Infectious Diseases UNC School of Medicine University of North Carolina At Chapel Hill Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1369-3224","authenticated-orcid":false,"given":"Jintanat","family":"Ananworanich","sequence":"additional","affiliation":[{"name":"U.S. Military HIV Research Program Walter Reed Army Institute of Research Silver Spring MD USA"},{"name":"Henry M. 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