Ten Years of Screening and Testing for Acute HIV Infection in North Carolina

OBJECTIVE:

To describe demographic and behavioral characteristics of persons with acute HIV infection (AHI) over time.

METHODS:

We conducted a retrospective assessment of AHI identified through the Screening and Tracing Active Transmission (STAT) program from 2003 to 2012 in North Carolina (NC). AHI was identified using pooled nucleic acid amplification for antibody negative samples and individual HIV-1 RNA for antibody indeterminate samples. The STAT program provides rapid notification and evaluation. We compared STAT-collected demographic and risk characteristics with all persons requesting tests and all non-AHI diagnoses from the NC State Laboratory of Public Health.

RESULTS:

The STAT Program identified 236 AHI cases representing 3.4% of all HIV diagnoses. AHI cases were similar to those diagnosed during established HIV. On pretest risk-assessments, AHI cases were 

• predominately black (69.1%), 
• male (80.1%), 
• young (46.8% < 25 years), 
• and men who have sex with men (MSM) (51.7%). 

Per post-diagnosis interviews, the median age decreased from 35 (interquartile range 25-42) to 27 (interquartile range 22-37) years, and the proportion <25 years increased from 23.8% to 45.2% (trend P = 0.04) between 2003 and 2012. AHI men were more likely to report MSM risk post-diagnosis than on pretest risk-assessments (64%-82.9%; P < 0.0001). Post-diagnosis report of MSM risk in men with AHI increased from 71.4% to 96.2%.

CONCLUSIONS:

In NC, 3.4% of individuals diagnosed with HIV infection have AHI. AHI screening provides a real-time source of incidence trends, improves the diagnostic yield of HIV testing, and offers an opportunity to limit onward transmission.

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By:  Kuruc JD1, Cope AB, Sampson LA, Gay CL, Ashby RM, Foust EM, Brinson M, Barnhart JE, Margolis D, Miller WC, Leone PA, Eron JJ.

• 1*Division of Infectious Disease, Department of Medicine (https://www.med.unc.edu/medicine), University of North Carolina at Chapel Hill, Chapel Hill, NC;†Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC; and‡Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
• J Acquir Immune Defic Syndr. 2016 Jan 1;71(1):111-9. doi: 10.1097/QAI.0000000000000818. 

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