August 6, 2008
Dr. Kevin Fenton who oversees the CDC's prevention efforts for HIV/AIDS, said new data from the Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS) will be available in the fall to provide the "clearest picture of the US epidemic."
STARHS is able to determine how many people become infected with HIV during the year, and it can gauge the spread of the disease among African-American heterosexuals, women and children. The test, officials said, is also able to determine if the HIV infection occurred within the last five months.
In the past, testers have been able to determine when the disease was diagnosed, but not when a person was initially infected.
One medical expert likened the new technology to adding a good speedometer to a car. Scientists had a good general idea of where the epidemic was going; this provides a better understanding of how fast it's moving right now.
For African-Americans, who represent nearly half of the 56,300 newly reported HIV cases; the STARHS test could be instrumental in saving lives by prompting African-Americans to seek treatment before the virus turns deadly.
"This is a fantastic tool we now have at our disposal," said Fenton, who spoke during a telephone conference interview with Black journalists. "While we know by other data, the impact the disease is having on Black gay men, this information about heterosexuals who are severely impacted was never known. For Blacks, the rate was seven times that of whites, and three times that of Hispanics. Twenty-five thousand newly diagnosed AIDS infections are occurring within the Black community every year."
He added, "The CDC is very committed to subgroup analysis. We want to know what is happening with Black women, Black men (heterosexuals). Now that we are confident, in autumn 2008, we will be moving towards publishing (a report). Part of our ongoing commitment is to get the data out."
STARHS has claimed the spotlight during the international conference, because of the new CDC report that revealed the spread of HIV in the U.S was 40 percent more widespread than previously known.
Since AIDS surfaced in 1981, health and government officials have struggled to estimate how many people are infected each year with HIV. It can take up to a decade for someone infected with HIV to show symptoms or become ill.
Previous CDC estimates said as many as 1.2 million Americans are living with AIDS. That estimate was based on the assumption of 40,000 new infections a year.
According to the study, the number of new infections each year never dropped below 50,000. That occurred in the early 1990s, and the epidemic's growth remained at that level until the late 1990s. At that time the number of new infections spiked to between 55,000 and 58,500, where it has stayed since. In 2006, according to the study, there were 56,300 new infections, 45 percent of which were among African Americans.
Fenton said the CDC began using the STAHRS system in 2005 when it became available. The new figures were known to CDC by last fall, but the results were not released until the conference because CDC officials wanted the HIV incidence surveillance system to undergo scientific review to insure its reliability.
STARHS involves a combination of two tests: a conventional HIV diagnostic test and a test known as the BED. Its full name is the BED HIV-1 Capture Enzyme Immunoassay. The conventional test identifies whether HIV antibodies are present in the body. A positive test result indicates that a person is infected, but not when the infection occurred.
The BED test, which measures the level of anti-HIV IgG relative to total IgG, is then applied to leftover serum from a positive HIV test. If the BED test detects a proportion of HIV-specific IgG below a certain threshold, the result indicates that the individual was infected with HIV in the previous five months. Such infections are considered new. The conventional test tells us if the person is infected with HIV, the BED test tells how recently.
The new estimate relies on blood tests from 22 states where health officials have been using the STARHS' HIV testing method.
"We then extrapolated the results to the entire United States by applying the observed ratio of HIV incidence to AIDS diagnoses in the 22 states to the areas without HIV incidence surveillance," said Dr. Irene Hill, chief of the HIV Incidence and Case Surveillance Branch in the Division of HIV/AIDS Prevention at the CDC. "This work represents collaboration at its best and the result is the clearest picture to date of new HIV infections in the United States."
Jerry Thomas is the CEO of Jerry Thomas PR, based in Chicago. www.jerrythomaspr.com