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

Abstract

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 HIV transmission, who would have been missed by routine HIV counseling and testing protocols. Further evaluation of the addition of HIV RNA screening to routine HIV antibody testing is warranted.

Alternative Algorithms for Human Immunodeficiency Virus Infection Diagnosis Using Tests That Are Licensed in the United States

“…Some indication of the relative numbers of early infection and established infection can be gleaned from surveys for primary HIV infection. In these studies, the population is screened by EIA, and EIA-negative specimens are screened by NAAT (2,26,33,35,36,36,37,39). The incremental yield of HIV-1 infections detected over that of serology alone ranges from 0 to 11% (33,(35)(36)(37)39).…”

“…Simple, rapid tests have become available that enable testing at the point of client contact in outreach settings outside the laboratory, and an algorithm composed exclusively of tests that can be performed on site while the client waits would be highly desirable (6,14,15,24,38). Nucleic acid amplification tests (NAAT) have been used to identify primary HIV infection before seroconversion and may have an appropriate and useful role in screening and diagnostic algorithms (2,6,26,31,33,35,36,36,37,39,41). Because of all these developments and recognition that separate algorithms may be adequate for different purposes, we evaluated the performance of FDA-approved tests in the context of multiple diagnostic algorithms.…”

Mobile Device for Disease Diagnosis and Data Tracking in Resource-Limited Settings

“…Previous studies have shown that rapid tests often fail to correctly identify weakly positive samples (19 ) such as those from recent HIV infections, which can constitute 0.3% to 3% of HIV-infected patients in high-risk populations with patients seeking care for bacterial sexually transmitted infections at sexually transmitted disease clinics and patients reporting fever in areas of high HIV prevalence (35,36 ). Furthermore, rapid tests operated in resource-limited settings have exhibited lower accuracy due in part to the difficulty in interpreting weak signals (18,19 ).…”

Integrating Acute HIV Infection within Routine Public Health Surveillance Practices in New York City

“…21 While effective in increasing the detection of AHI, such pNAAT programs are costly, and targeting their use to the highest-yield populations to maximize efficiency has been recommended. 19,22,23 In 2009, the Food and Drug Administration (FDA) approved a fourth-generation antigen (Ag)/antibody (Ab) HIV diagnostic test that is expected to make AHI screening more efficient and less expensive. Several jurisdictions, including NYC, are being funded by the Centers for Disease Control and Prevention (CDC) to evaluate the new test's ability to detect AHI compared with pNAAT.…”

“…The diagnostic challenge posed by AHI has inspired screening efforts involving complex and expensive laboratory procedures using pooled nucleic acid amplification test (pNAAT) algorithms. 5,15,16 Programs designed to increase the ascertainment of AHI by pNAAT have been conducted and described in North Carolina, 5,17 Seattle (Washington), 18 Los Angeles (California), 19 San Francisco (California), 20 and New York City (NYC). 21 While effective in increasing the detection of AHI, such pNAAT programs are costly, and targeting their use to the highest-yield populations to maximize efficiency has been recommended.…”