The New York Times - Wednesday, February 11, 2004
Lawrence K. Altman

The outbreak, reported here on Tuesday at the 11th annual Conference on Retroviruses and Opportunistic Infections, involved 84 H.I.V. cases in male students ages 18 to 30 from Jan. 1, 2000, through Dec. 31, 2003. The students, most of whom were black, were enrolled in 37 colleges, all but 4 in North Carolina.

"We believe that this is a wake-up call" to direct new efforts to prevent further transmission of the virus among young people, said Dr. Lisa B. Hightow of the University of North Carolina. Dr. Hightow is an infectious disease specialist who worked with the North Carolina health department.

Her team investigated the outbreak using the new test, which is based on a technique known as P.C.R. (for polymerase chain reaction) and which can detect H.I.V., the AIDS virus, weeks earlier than the standard test. The initial weeks of H.I.V. infection is a period when the virus is easily transmitted because it is present in large amounts in the blood and semen.

Most of the 84 students had tested negative with the standard H.I.V. antibody test.

North Carolina's program has used the P.C.R. test since November 2002 with the aim of detecting cases in the first weeks of infection. The health department has long interviewed each new infected person to help trace partners and prevent further transmission of H.I.V.

In December 2002 and January 2003, two male students at the same college in the same town went for H.I.V. testing. Their initial antibody tests were negative, but both students were found to be positive using the new test.

Further testing and investigation led to the detection of 6 cases in male college students ages 18 to 30 in 2000; 19 in 2001; 29 in 2002; and 30 in 2003. Of the 84 students, 73, or 88 percent, were black and 11 were white.

In the same period, 651 cases were detected in men of the same age who were not enrolled in college.

The investigation involved only men, so officials do not know how many women the men infected. But, Dr. Hightow said, "there is no reason to think that women are not at risk."

In the year preceding their diagnosis, 4 percent of the students said they had had sex only with women; 58 percent had sex only with men; and 33 percent had had sex with both men and women. There was no information about the other 5 percent.

About half the men said they acquired their infection from another person who knew he or she had long been infected but who did not disclose the infection.

The epidemiologists did not identify any person who transmitted the virus to numerous partners.

Dr. Peter Leone, medical director of North Carolina's sexually transmitted disease program, said the program cost about $300,000 for the 120,000 tests it did each year. That represents about $2 a test more than the standard antibody test alone.

Dr. Harold W. Jaffe, the head of the AIDS program at the federal Centers for Disease Control and Prevention, which assisted in the investigation, said that in the 1990's a different kind of survey found low rates of H.I.V. infection on 10 college campuses but not the kind of network uncovered in North Carolina.

In another report at the conference, the largest study of surgical outcomes among patients treated for H.I.V. infection found that they fared as well as noninfected patients.

The study involved infected members of the Kaiser-Permanente health system in northern California who underwent a number of surgical procedures from July 1997 to June 2002. They included operations on the heart; to remove an inflamed appendix, gallbladder or uterus; to remove cancers from the breast and colon; andrepair hernias and joints.

A Kaiser-Permanente team led by Dr. Michael Horberg analyzed the charts of 641 infected patients and 256 of 395 noninfected patients. A year after surgery, there were seven deaths among the infected patients and two among the noninfected. But the team attributed the deaths in infected patients to pre-existing conditions other than H.I.V. infection.

Infected patients with a viral count greater than 10,000 at the time of surgery had a higher rate of complications, 23 percent, compared with 8 percent among those with a count less than 10,000. The team undertook the study because doctors had a perception that suppressed immune function from H.I.V. would lead to a worse surgical outcome among infected patients. The team concluded that "H.I.V. status should not by itself be a criterion for surgical consideration."

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