Transcript HIV Testing Practices

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
Percent of Persons Ever Tested and Tested in
the Preceding 12 Months - NHIS 2002-2006
Ever tested
Preceding 12 months
50
30
20
10
0
19
87
19
8
19 8
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
Percent
40
- MMWR August 8, 2008
Early Indications of Progress:
National Health Interview Survey
Ever Tested
Last 12 months
2005
70,036,336 (39.9%)
18,042,610 (10.44%)
2006
71,468,420 (40.4%)
17,775,006 (10.39%)
2007
73,848,002 (41.3%)
18,791,895 (10.67%)
2008
80,172,602 (44.6%)
19,055,402 (10.74%)
8.7 million
1.3 million
Change since
2006:
Source: National Health Interview Survey
Estimated Cases of HIV/AIDS, by year of diagnosis
(based on 34 States with Confidential HIV Reporting)
2004
37,164
2005
36,640
2006
37,193
2007
42,655
Change:
5462 (15%)
Source: HIV/AIDS Surveillance Report, 2007
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
Progress: Total Tests
Cumulative Tests
Avg Tests/Month
Oct-Mar 2008
87,038
14,506
Apr-Sept 2008
446,503
37,209
Oct – Mar 2009
859,882
47,771
April 2009
932,157
49,061
May 2009
1,027,059
51,353
June 2009
1,136,067
54,098
July 2009
1,221,680
55,531
Percentage of Tests and New HIV+ Tests
Total Tests
39
HIV+ Tests
34
26
22
18
13
14
16
5.3 5.6
er
Oth
CH
Cs
Cl i
ni c
s
TB
e
bu
s
tA
Su
bs
ct i
on
s
Co
rre
s
re
Ca
en
t
Urg
ati
en
1.2 0.7
1.1 0.9
0.7
lin
ic
1
ST
DC
1
t
1.4
Inp
45
40
35
30
25
20
15
10
5
0
ED
s
Percent of Tests
by Venue, Sept 2007 through March 2009
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
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
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
Total
Tested
Age Group (yrs)
HIV
Prevalence
No. %
Unrecognized
HIV Infection
No. %
18-24
25-29
30-39
40-49
≥ 50
410
303
585
367
102
57
53
171
137
32
(14)
(17)
(29)
(37)
(31)
45
37
83
41
11
(79)
(70)
(49)
(30)
(34)
Race/Ethnicity
White
Black
Hispanic
Multiracial
Other
616
444
466
86
139
127
206
80
16
18
(21)
(46)
(17)
(19)
(13)
23
139
38
8
9
(18)
(67)
(48)
(50)
(50)
1,767
450
(25)
217
(48)
Total
MMWR June 24, 2005
Pooled RNA Screening for Acute HIV Infection
CDC Acute HIV Infection Study
1-Stage Pooling
16 Specimens
A B C D E
1 Master Pool
F G H I J K L M N O P
Yield from Pooled RNA Screening after EIA
Number
tested
HIV Ab+
RNA+/ Ab-
Florida – 2006-08
54,948
663 (1.2%)†
9 (0.02%)
L.A. - 2006-08
37,012
427 (1.2%)*
35 (0.09%)
Site
†Screened
with Bio-Rad 1-2 Plus O
*Screened with Vironostika EIA
- Patel et al, CDC , Archives Int Med 2010
Yield from Pooled RNA Screening after EIA
Number
tested
HIV Ab+
RNA+/ Ab-
Florida – 2006-08
54,948
663 (1.2%)†
9 (0.02%)
L.A. - 2006-08
37,012
427 (1.2%)*
35 (0.09%)
L.A. - 2006-08
37,012
441 (1.2%)†
18 (0.05%)
Site
†Screened
with Bio-Rad 1-2 Plus O
*Screened with Vironostika EIA
- Patel et al, CDC , Archives Int Med 2010
Yield from Pooled RNA Screening after Rapid Test
Site
Florida
New York
Number
tested
HIV Ab+
RNA+/ Ab-
604
17 (2.8%)
1 (0.2%)
6,547
29 (0.4%)
7 (0.1%)
- Patel et al, CDC , Archives Int Med 2010
Yield from Pooled RNA Screening after Rapid Test
Number
tested
HIV Ab+
RNA+/ Ab-
604
604
17 (2.8%)*
17 (2.8%) †
1 (0.2%)
New York
6,547
29 (0.4%)*
7 (0.1%)
New York
6,547
35 (0.5%) †
1 (0.02%)
Site
Florida
Florida
* Screened with OraQuick
†Screened with BioRad 1-2 Plus O
- Patel et al, CDC , Archives Int Med 2010
1 (0.2%)
Acute HIV Screening: 99,111 tested
EIA-RR/WB+
NAAT+
NAATEIA-RR/WB-ind
1,136 (1.1%)
1,094 (96.3%)
42 (3.7%)
30 (0.03%)
NAAT+
3 (10.0%)
NAAT-
27 (90.0%)
EIA-neg/NAAT+
52 (0.05%)
Acute HIV
48 (92%)
False-pos NAAT
4 (8%)
- Patel et al, Archives Int Med 2010
Acute HIV Screening: 99,111 tested
EIA-RR/WB+
NAAT+
NAATEIA-RR/WB-ind
1,136 (1.1%)
1,094 (96.3%)
42 (3.7%)
30 (0.03%)
NAAT+
3 (10.0%)
NAAT-
27 (90.0%)
EIA-neg/NAAT+
52 (0.05%)
Acute HIV
48 (92%)
False-pos NAAT
4 (8%)
- Patel et al, Archives Int Med 2010
Acute HIV Screening: 99,111 tested
EIA-RR/WB+
NAAT+
NAATEIA-RR/WB-ind
1,136 (1.1%)
1,094 (96.3%)
42 (3.7%)
30 (0.03%)
NAAT+
3 (10.0%)
NAAT-
27 (90.0%)
EIA-neg/NAAT+
52 (0.05%)
Acute HIV
48 (92%)
False-pos NAAT
4 (8%)
- Patel et al, Archives Int Med 2010
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
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
Potential Prevention Research Questions

Indications for and frequency of retesting

Role of acute infection in sustaining the
epidemic

Community trial of structured serosorting
intervention