HIV Testing and Considerations for Prevention

Bernard M. Branson, M.D.

Associate Director for Laboratory DiagnosticsDivisions of HIV/AIDS Prevention

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Centers for Disease Control and Prevention

HIV Testing andConsiderations for Prevention

Percent of Persons Ever Tested and Percent of Persons Ever Tested and Tested in the Preceding 12 Months Tested in the Preceding 12 Months

- NHIS 2002-2006- NHIS 2002-2006

0

10

20

30

40

50

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Perc

ent

Ever tested Preceding 12 months

- MMWR August 8, 2008

Early Indications of Progress:National Health Interview

SurveyEver 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%)

Change since 2006:

8.7 million 1.3 millionSource: 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

Change:

42,655

5462 (15%)

Source: HIV/AIDS Surveillance Report, 2007

CDC’s Expanded Testing Initiative

Test 1.5 million persons per year among populations disproportionately affected by HIV, primarily African-Americans.

Identify 20,000 new HIV infections

Funded September 2007

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

by Venue, Sept 2007 through March 2009

34

1.4 1

26

13

1.1 1.2

18

5.3

39

1 0.7

22

14

0.9 0.7

16

5.6

05

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ests

Total Tests HIV+ Tests

HIV Testing Among IDU

HIV Testing Survey, 1998-1999• 90% previously tested

5 cities, 1998 – 2002*

• 93% previously tested• 69% tested within previous year

- Kellerman et el, JAIDS 2002- Heimer et al, AJPH 2007

*Chicago IL, Hartford CT, New Haven CT, Oakland CA, Springfield MA

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

Total Tested

HIVPrevalence

No. %

Unrecognized HIV Infection

No. %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)

Race/EthnicityWhite 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)

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

MMWR June 24, 2005

Pooled RNA Screening for Acute HIV Infection

1 Master Pool

1-Stage Pooling

16 Specimens A B C D E F G H I J

CDC Acute HIV Infection Study

K L M N O P

Yield from Pooled RNA Screening after EIA

SiteNumber 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%)

†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

SiteNumber 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%)

†Screened with Bio-Rad 1-2 Plus O *Screened with Vironostika EIA


Yield from Pooled RNA Screening after Rapid Test

SiteNumber tested

HIV Ab+

RNA+/ Ab-

Florida 604 17 (2.8%) 1 (0.2%)

New York 6,547 29 (0.4%) 7 (0.1%)


Yield from Pooled RNA Screening after Rapid Test

SiteNumber tested

HIV Ab+

RNA+/ Ab-

Florida 604 17 (2.8%)* 1 (0.2%)Florida 604 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%)

* Screened with OraQuick †Screened with BioRad 1-2 Plus O


Acute HIV Screening: 99,111 tested

EIA-RR/WB+ 1,136 (1.1%)

NAAT+ 1,094 (96.3%)

NAAT- 42 (3.7%)

EIA-RR/WB-ind 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

- Shepard et al, MMWR 2009- Patel et al, Archives Int Med 2010

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

HIV Testing and Considerations for Prevention

Documents

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