Performance of Determine Combo & Other Point-of-Care HIV Tests among Seattle MSM

Highlights

• Point-of-care HIV tests fail to detect many persons with early HIV infection.
• Oral fluid identifies fewer persons with HIV infection compared to fingerstick.
• Some differences were seen among the fingerstick point-of-care tests.
• Determine Combo detected only one case of acute HIV infection.
• Specificity of Combo may be a limitation to use in low prevalence settings.

BACKGROUND AND OBJECTIVE:

The rapid test study was a real-time comparison of point-of-care (POC) HIV tests to determine their abilities to detect early HIV infection.

STUDY DESIGN:

Men and transgender persons reporting sex with men in the prior year were recruited at the Public Health-Seattle & King County STD Clinic, Gay City Health Project, and University of Washington Primary Infection Clinic. Study tests included the OraQuick ADVANCE Rapid HIV-1/2 Antibody Test performed on oral fluids and tests performed on fingerstick whole blood specimens including OraQuick, Uni-Gold Recombigen HIV test, Determine HIV-1/2 Ag/Ab Combo, and INSTI HIV-1 Rapid Antibody Test. Specimens from subjects with negative results were sent for EIA and nucleic acid amplification testing. McNemar's exact tests compared the numbers of HIV-infected subjects detected.

RESULTS:

Between February 2010 and August 2014, there were 3438 study visits. Twenty-four subjects had discordant POC results with at least one reactive and one non-reactive test, including one subject with a reactive Determine p24 antigen. OraQuick performed on oral fluids identified fewer persons compared to all fingerstick tests. OraQuick performed on fingerstick whole blood detected fewer persons compared to the Determine Combo antibody component (p=.008) and Combo overall (p=.004), and there was a trend when compared to INSTI (p=.06). The Determine Combo specificity was 98.99%.

CONCLUSIONS:

As reported by others, Determine Combo underperforms compared to laboratory-based testing, but it did detect one acute infection. If these results are validated, the specificity of Determine Combo may limit its usefulness in populations with lower HIV incidence.

Purchase full article at:   http://goo.gl/h6qXBa

By:  Stekler JD1, Ure G2, O'Neal JD3, Lane A4, Swanson F5, Maenza J2, Stevens C2, Coombs RW6, Dragavon J7, Swenson PD4, Golden MR8.

• 1Departments of Medicine, University of Washington, Seattle, WA, United States; Departments of Epidemiology, University of Washington, Seattle, WA, United States; Public Health-Seattle & King County, Seattle, WA, United States. Electronic address: jstekler@uw.edu.
• 2Departments of Medicine, University of Washington, Seattle, WA, United States.
• 3San Francisco AIDS Foundation, San Francisco, CA, United States.
• 4Public Health-Seattle & King County, Seattle, WA, United States.
• 5Gay City Health Project, Seattle, WA, United States.
• 6Departments of Medicine, University of Washington, Seattle, WA, United States; Departments of Laboratory Medicine, University of Washington, Seattle, WA, United States.
• 7Departments of Laboratory Medicine, University of Washington, Seattle, WA, United States.
• 8Departments of Medicine, University of Washington, Seattle, WA, United States; Departments of Epidemiology, University of Washington, Seattle, WA, United States; Public Health-Seattle & King County, Seattle, WA, United States. 
• J Clin Virol. 2016 Jan 2;76:8-13. doi: 10.1016/j.jcv.2015.12.011.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Time from HIV Diagnosis to Viral Load Suppression: 2007-2013

BACKGROUND:

US guidelines now recommend that all HIV-infected persons receive antiretroviral therapy). HIV prevention is increasingly focused on ensuring that infected persons are diagnosed soon after HIV acquisition and quickly link to care and initiate antiretroviral therapy. We examined trends in time from HIV diagnosis to viral load suppression in King County, WA, to gauge improvement in our HIV care continuum over time.

METHODS:

We used HIV surveillance data and Cox proportional hazards to evaluate how the time from diagnosis to viral suppression changed among persons newly diagnosed as having HIV in King County, WA, between 2007 and 2013.

RESULTS:

A total of 1490 (84%) of 1766 newly diagnosed persons achieved viral suppression in a median time of 213 days (95% confidence interval, 203-229). Thirty-six percent of all persons diagnosed in 2007 and 77% in 2013 were virally suppressed within 12 months of HIV diagnosis (P < 0.0001). Differences in time to suppression by calendar year persisted when stratifying by CD4 count at diagnosis. Race was not significantly associated with time to viral suppression.

CONCLUSIONS:

Time from HIV diagnosis to viral suppression dramatically declined between 2007 and 2013, and more than three quarters of recently HIV-diagnosed individuals in King County, WA, now achieve viral suppression within a year of diagnosis. This improvement was evident among all persons newly diagnosed as having HIV, regardless of race/ethnicity or CD4 count at time of diagnosis.

Purchase full article at:   http://goo.gl/S1EDbg

By:   Toren KG1, Buskin SE, Dombrowski JC, Cassels SL, Golden MR.

• 1From the *Public Health-Seattle & King County HIV/STD Program, Seattle, WA; Departments of †Epidemiology and ‡Medicine, University of Washington, Seattle, WA; and §Department of Geography, University of California Santa Barbara, Santa Barbara, CA. 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

Health Behaviors of Young Adult Heroin Injectors in the Seattle Area

Highlights

• Younger heroin injectors engage in risky injection practices more than older heroin injectors.
• Younger heroin injectors re-use syringes and share syringes more than older heroin injectors.
• Younger heroin injectors are much less likely to report having tested positive for hepatitis C.
• Outreach and medical screening and care should address young adult injectors’ needs.

Abstract

Background

Recent indicators point to substantial increases in the number of young heroin users across much of the United States as well as across Washington State. This study characterizes this younger generation of heroin injectors in order to inform public health responses.

Methods

A cross-sectional analysis was conducted using street-intercept surveys at King County, WA syringe exchange programs in 2013. Survey responses were restricted to heroin injectors (n = 389) and then categorized by the participant's age (<30 and ≥30) for a descriptive epidemiological analysis. A manual stepwise logistic regression tested the independent relationship of user characteristics with being under the age of 30.

Results

In regression analyses, adjusting for other characteristics, young adults were significantly (p < 0.05) more likely to: re-use syringes 2–4 times (OR = 2.28 compared to those who used a syringe once), share syringes (OR = 2.92), report they were “hooked on” prescription-type opioids prior to using heroin (OR = 2.54), have had a sexual partner in the prior year (opposite sex OR = 7.37, same sex OR = 23.29, both genders OR = 22.04), and report powder cocaine use in the prior 3 months (OR = 2.49) compared to those ages 30 and older. Young adults were significantly less likely to report using pain medicines (OR = 0.33), having an abscess in the prior year (OR = 0.33) or having tested positive for hepatitis C (OR = 0.22) than older adults adjusting for other variables.

Conclusions

Younger heroin injectors engage in risky injection practices more than older heroin injectors. Along with other significant differences, these findings have implications for outreach programs and medical care for younger heroin injectors.

Purchase full article at:  http://goo.gl/JLnwVm

By:  Emily R. Cedarbaum, Caleb J. Banta-Green

Affiliations

• Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St, Suite 120, Seattle, WA 98105-4631, United States

Correspondence

• Corresponding author. Tel.: +1 206 685 3919; fax: +1 206 543 5473.

More at:  https://twitter.com/hiv_insight

And:        http://twitter.com/Prison_Health

Seattle/King County Homeless Counts

Via:  http://ht.ly/Uvyob  MT https://twitter.com/jbwogan