Acute HIV-1 Infection in the Southeastern United States: A Cohort Study

Abstract

In 1998 a collaboration between Duke University and the University of North Carolina, Chapel Hill (UNC) was founded to enhance identification of persons with acute HIV-1 infection (AHI). The Duke-UNC AHI Research Consortium Cohort consists of patients ‡ 18 years old with a positive nucleic acid amplification test (NAAT) and either a negative enzyme immunoassay (EIA) test or a positive EIA with a negative/indeterminate Western blot. Patients were referred to the cohort from acute care settings and state-funded HIV testing sites that use NAAT testing on pooled HIV-1 antibody-negative samples. Between 1998 and 2010, 155 patients with AHI were enrolled: 81 (52%) African-Americans, 63 (41%) white, non-Hispanics, 137 (88%) males, 108 (70%) men who have sex with men (MSM), and 18 (12%) females. The median age was 27 years . Most (n = 138/155) reported symptoms with a median duration of 17.5 days. The median nadir CD4 count was 408 cells/mm 3 (IQR 289-563); the median observed peak HIV-1 level was 726,859 copies/ml (IQR 167,565,728). The emergency department was the most frequent site of initial presentation (n = 55/152; 3 missing data). AHI diagnosis was made at time of first contact in 62/137 (45%; 18 missing data) patients. This prospectively enrolled cohort is the largest group of patients with AHI reported from the Southeastern United States. The demographics reflect the epidemic of this geographic area with a high proportion of African-Americans, including young black MSM. Highlighting the challenges of diagnosing AHI, less than half of the patients were diagnosed at the first healthcare visit. Women made up a small proportion despite increasing numbers in our clinics.

Incident Sexually Transmitted Infection as a Biomarker for High-Risk Sexual Behavior After Diagnosis of Acute HIV

“…14,16 AHI was defined as a negative or indeterminate enzyme immunoassay or a negative HIV RNA test within 45 days of study enrollment plus reproducibly detectable HIV RNA by amplification methods. Patients enrolled in the observational cohort study typically maintain contact with HIV care providers at UNC or Duke University at least once every six months.…”

Fixed-dose combination emtricitabine/tenofovir/efavirenz initiated during acute HIV infection; 96-week efficacy and durability

“…As in the prior report, our primary goal was to demonstrate that rapid linkage of acutely-infected individuals to simple, effective ART would facilitate prompt and sustained HIV-1 suppression. Although fixed-dose combination FDC FTC/TDF/EFV is no longer a recommended first line regimen in the United States [2], our findings inform decisions on the provision of ART for acutely infected individuals related to pill burden, postponement of treatment for results of resistance testing, the risk of virologic failure and de novo resistance, as well as adherence and retention, particularly among young men who have sex with men (MSM), a group that comprises a majority of acutely infected individuals in the Southeastern United States [19, 20]. …”

Prevalence of Undiagnosed Acute and Chronic HIV in a Lower-Prevalence Urban Emergency Department

“…58 However, there was no confirmatory antibody testing in this study. If this sample is not counted, the proportion with acute infection would be 0.2% (95% CI = 0.05%, 0.70%), with one third of undetected infections being from acute HIV.…”