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HIV Testing and Considerations for Prevention

HIV Testing and Considerations for Prevention. Bernard M. Branson, M.D. Associate Director for Laboratory Diagnostics Divisions of HIV/AIDS Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Centers for Disease Control and Prevention.

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HIV Testing and Considerations for Prevention

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  1. HIV Testing andConsiderations for Prevention Bernard M. Branson, M.D. Associate Director for Laboratory Diagnostics Divisions of HIV/AIDS Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Centers for Disease Control and Prevention

  2. Percent of Persons Ever Tested and Tested in the Preceding 12 Months - NHIS 2002-2006 - MMWR August 8, 2008

  3. Early Indications of Progress:National Health Interview Survey Source: National Health Interview Survey

  4. Estimated Cases of HIV/AIDS, by year of diagnosis(based on 34 States with Confidential HIV Reporting) Source: HIV/AIDS Surveillance Report, 2007

  5. CDC’s Expanded Testing Initiative Funded September 2007 • Test 1.5 million persons per year among populations disproportionately affected by HIV, primarily African-Americans. • Identify 20,000 new HIV infections

  6. Progress: Total Tests

  7. Total Tests HIV+ Tests Percentage of Tests and New HIV+ Testsby Venue, Sept 2007 through March 2009

  8. HIV Testing Among IDU • HIV Testing Survey, 1998-1999 • 90% previously tested • 5 cities, 1998 – 2002* • 93% previously tested • 69% tested within previous year *Chicago IL, Hartford CT, New Haven CT, Oakland CA, Springfield MA - Kellerman et el, JAIDS 2002 - Heimer et al, AJPH 2007

  9. HIV Testing Among MSM • Young MSM study, 1998-2000 • 88% previously tested, 54% in previous year • National HIV Behavioral Surveillance 2003-2005: • 92% previously tested, 77% in previous year • 57,131 MSM visits to STD clinics, Denver, DC, San Francisco, Seattle • 94% previously tested • Median inter-test interval 243 days - MacKellar et al, Sex Transm Diseases 2006 - CDC, MMWR Surveillance Summaries 2006 -Helms et al, JAIDS 2009

  10. HIV Prevalence and Proportion of Unrecognized HIV Infection Among 1,767 MSM, by Age Group and Race/Ethnicity NHBS, Baltimore, LA, Miami, NYC, San Francisco Age Group (yrs) 18-24 410 57 (14) 45 (79) 25-29 303 53 (17) 37 (70) 30-39 585 171 (29) 83 (49) 40-49 367 137 (37) 41 (30) ≥ 50 102 32 (31) 11 (34) Unrecognized HIV Infection No. % HIV Prevalence No. % Total Tested Race/Ethnicity White 616 127 (21) 23 (18) Black 444 206 (46) 139 (67) Hispanic 466 80 (17) 38 (48) Multiracial 86 16 (19) 8 (50) Other 139 18 (13) 9 (50) Total 1,767 450 (25) 217 (48) MMWR June 24, 2005

  11. Pooled RNA Screening for Acute HIV Infection

  12. CDC Acute HIV Infection Study 1-Stage Pooling 16 Specimens A B C D E F G H I J K L M N O P 1 Master Pool

  13. Yield from Pooled RNA Screening after EIA †Screened with Bio-Rad 1-2 Plus O *Screened with Vironostika EIA - Patel et al, CDC , Archives Int Med 2010

  14. Yield from Pooled RNA Screening after EIA †Screened with Bio-Rad 1-2 Plus O *Screened with Vironostika EIA - Patel et al, CDC , Archives Int Med 2010

  15. Yield from Pooled RNA Screening after Rapid Test - Patel et al, CDC , Archives Int Med 2010

  16. Yield from Pooled RNA Screening after Rapid Test *Screened with OraQuick †Screened with BioRad 1-2 Plus O - Patel et al, CDC , Archives Int Med 2010

  17. Acute HIV Screening: 99,111 tested - Patel et al, Archives Int Med 2010

  18. Acute HIV Screening: 99,111 tested - Patel et al, Archives Int Med 2010

  19. Acute HIV Screening: 99,111 tested - Patel et al, Archives Int Med 2010

  20. Acute Infections in MSM detected by NAAT • 0.3% of 14,005 frequently tested MSM in Seattle STD clinic; represent 20% of all HIV infections detected • 26 (74%) of 35 AHI cases detected in LA at MSM clinic; 25% of all HIV infections detected • 0.08% of 21,425 STD clinic patients in New York City; represent 9% of all HIV infections detected; 94% were MSM - Stekler et al, Clin Infect Dis 2009 - Patel et al, Archives Int Med 2010 - Shepard et al, MMWR 2009

  21. 4th Generation vs. RNA • RNA+/ 3rd gen-negative specimens detected by 4th generation EIA: • 38 of 46 (83%) – Australia* • 10 of 14 (71%) – CDC AHI study** • 51 of 61 (84%) – CDC panel*** • 4 days after RNA – 9 seroconversion panels*** * Cunningham P, HIV Diagnostics Conf 2007 ** Patel P, CROI 2009 *** Owen M, CROI 2009

  22. Potential Prevention Research Questions • Indications for and frequency of retesting • Role of acute infection in sustaining the epidemic • Community trial of structured serosorting intervention

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