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Detection of Acute HIV Infections in High-Risk Patients in California

June 30, 2006

In light of the strong relation between STDs and the spread of HIV, recent outbreaks of syphilis in the United States could lead to increased rates of new HIV infection, noted the authors of the current study. STD clinics that serve populations at risk for syphilis would be logical sites to monitor rates of acute HIV infection. However, the detection of acute HIV infection is not routine and requires the use of HIV RNA testing in combination with HIV antibody testing.

To determine the rate of acute HIV infection, the authors performed HIV RNA testing on pooled HIV antibody-negative specimens from persons seeking treatment at San Francisco City Clinic (SFCC) and from men seeking care at three STD clinics in Los Angeles. A comparison was made of acute HIV infection prevalence among those groups.

From October 2003 to July 2004, the researchers tested 3,075 specimens from patients at SFCC, of which 105 (3 percent) were HIV antibody-positive and 11 were HIV RNA-positive/HIV antibody-negative. This resulted in a prevalence of acute HIV infection of 36 per 10,000 (95 percent confidence interval [CI]: 26 to 50 per 10,000) and increasing by 10.5 percent the diagnostic yield of HIV RNA testing compared with standard testing.

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From February 2004 to April 2004, 1,712 specimens from male patients at three Los Angeles STD clinics were tested, of which 14 (0.82 percent) were HIV-positive by enzyme immunoassay testing and 1 was HIV RNA-positive/HIV antibody-negative, giving an acute infection prevalence of 6 per 10,000 (95 percent CI: 3 to 13 per 10,000) and increasing the diagnostic yield for HIV infection by 7.1 percent.

"In our study, the addition of HIV RNA screening to routine HIV antibody testing in STD clinics identified a substantial increased proportion of HIV-infected persons at high risk for further transmission, who would have been missed by routine HIV counseling and testing protocols," the researchers concluded. "Further evaluation of the addition of HIV RNA screening to routine HIV antibody testing is warranted."

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Adapted from:
Journal of Acquired Immune Deficiency Syndromes
05.2006; Vol. 42; No. 1: P. 75-79; Pragna Patel, M.D., M.P.H.; Jeffrey D. Klausner, M.D., M.P.H.; Oliver M. Bacon, M.D.; Sally Liska, Dr.P.H.; Melanie Taylor, M.D., M.P.H.; Anthony Gonzalez, Ph.D.; Robert P. Kohn, M.P.H.; William Wong, M.D..; Sydney Harvey,M.D.; Peter R. Kerndt, M.D., M.P.H.; Scott D. Holmberg, M.D.


  
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This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.
 
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