11th Conference on Retroviruses and Opportunistic Infections San Francisco, California - February 8 - 11, 2004

Conf Retroviruses Opportunistic Infect. 2004 Feb 8-11;11th:Abstract No. 20

C Pilcher¹, E Foust², J McPherson², R Ashby², J Owen-O'Dowd², T Nguyen¹, R Lee², S Fiscus¹, and P Leone^1
1Univ. of North Carolina at Chapel Hill, USA and ²North Carolina Dept. of Hlth. and Human Svcs., Raleigh, USA

BACKGROUND: Public health strategies are required to identify more early HIV infections. Adding nucleic acid testing (NAT) to HIV antibody testing can make routine diagnosis of antibody- acute HIV infection possible. The CDC's STARHS algorithm also identifies antibody+ clients with recent (<170d) seroconversion.

METHODS: For 1 month in 2001, and since November 2002, North Carolina's 110 public HIV-testing sites have offered enhanced VCT. Following EIA/WB testing, antibody- specimens are pooled 1:10:90, then screened by NucliSens NAT; only NAT+ pools are broken down. Since January 2003, Biomek FX robotic pooling has been used. Antibody- NAT+ clients are notified by a rapid response team providing counseling, confirmatory testing, partner notification, and entry to care. Antibody+ specimens undergo STARHS testing.

RESULTS: Of 109,788 clients tested through October 1, 2003, 622 were HIV infected (prevelance = 56.7 per 10,000). Of these, 21 had NAT+ antibody- acute HIV infection (prevelance =1.9 per 10,000). Of the 591antibody+ retested by STARHS, 121 had recent infection (prevelance =15.0 per 10,000). For clients not previously HIV+, NAT added +4.1% to the diagnostic yield of antibody testing (in jails: +11.1%; in STD clinics: +6.4%). Using manual pooling 3 false positive NATs occurred (n = 22,315, PPV = 0.75, Sp = 0.9999) vs 0 with robotic pooling (n = 88,428, PPV = 1.0000, Sp = 1.0000). Of 21 clients with acute HIV infection, 19 (including 1 pregnant woman) have been entered into care and offered ART. For North Carolina women receiving universal prenatal HIV testing, annual incidence (estimated by STARHS) was 0.08%. Testing sites with highest unadjusted incidence estimates were stand-alone testing sites (1.01%), urban community health centers (0.94%), jails (0.47%), and sexually transmitted diseases clinics (0.23%). All cases of acute or recent HIV infection have been located and mapped. Factors significantly associated with HIV infection in North Carolina in 2002-2003 included male gender, MSM status, African American ethnicity, and age younger than 24 years. HIV+ transmitters have been characterized for most cases of acute HIV infection. Sexual and social networks associated with active HIV transmission have been newly identified and targeted for prevention activities.

CONCLUSIONS: With HIV VCT enhanced by NAT, public helath programs can actively monitor HIV transmission in populations by identifying incident infections in real-time. The additional cases identified by NAT are those with maximm potential for secondary spread. The Screening and Tracing Active Transmission (STAT) program is a new model for increasing effectiveness of VCT-based HIV surveillance and prevention programs.

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Copyright © 2004 - Foundation for Retrovirology and Human Health. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Foundation for Retrovirology and Human Health. Licensed (AIDSLINE) from National Library of Medicine.