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Evaluation of six years of statewide screening and testing for acute HIV infection in North Carolina
J. Kuruc1, A. Mayo2, L. Sampson3, J. Barnhart3, M. Brinson4, E. Foust3, C. Pilcher5, S. McCoy6, C. Gay1, P. Leone1,7, J. Eron1
1University of North Carolina at Chapel Hill, Medicine, Chapel Hill, United States, 2University of North Carolina at Chapel Hill, Epidemiology, Chapel Hill, United States, 3North Carolina Department of Health and Human Services, Communicable Disease Branch, Raleigh, United States, 4North Carolina State Laboratory of Public Health, Raleigh, United States, 5University of California, San Francisco, United States, 6RTI-International, San Francisco, United States, 7North Carolina Department of Health and Human Services, Epidemiology, Raleigh, United States
Background: Since 2002, North Carolina (NC) has identified acute HIV infections (AHI) using nucleic acid amplification testing (NAAT) through a statewide program.
Methods: All HIV antibody negative serum samples from publicly funded sites are tested for HIV RNA using specimen pooling. We calculated AHI and chronic HIV prevalence by calendar year and used linear regression to test for trends over time. We compared characteristics of people with acute and chronic HIV infection.
Results: Between 11/1/2002 and 12/31/2008, 127 clients with AHI and 3752 with chronic HIV infection were identified from 893,842 tests for an overall prevalence of 0.014% and 0.42%. Prevalence declined from 2002-2008 (p=0.05 and p=0.001) in both groups. NAAT testing increased case identification by 3.3% over standard antibody testing alone. Acutes were younger (41% ≤24 vs. 28%; p=0.002), more likely to be men (79% vs. 72%, p=0.08) and white (27% vs. 20%, p=0.04) than chronics.
One in five acutes were adolescents (< 21 years old) of whom 60% (N=15) were identified from 2007-2008 (versus 2002-2006, p=0.006). Most adolescents were MSM of color (72%), compared to only 27% of adult acutes (p< 0.0001). AHI women (N=27) median age 30 (range 16-48) were predominantly African-American (74%), 5 were pregnant. HIV risk factors were self/partner incarceration (37%), crack (33%) and sex work (22%). Seven women´s (26%) sex partners were control measure violators. Women were more likely to have an STI within 8 weeks of their AHI diagnosis (48% vs. 22% of men, p=0.01).
Conclusions: AHI and chronic HIV prevalence has declined from 2002-2008 but AHI screening still improves diagnostic yield. Adolescents, especially young MSM of color, were more likely diagnosed with AHI. Women were less commonly diagnosed during AHI, potentially due to risk perception but further research is needed. Characterizing populations diagnosed with AHI may provide insight into improving early detection of HIV infection.
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