Detection of acute HIV-1 infections utilizing NAAT technology in Dallas, Texas.

BACKGROUND

The detection of an acute human immunodeficiency virus infection (AHI) is vital in the fight against the spread of HIV to uninfected partners. Detection early after transmission is critical because the virus is replicating at a high level and is undetectable by serological markers. Nucleic acid amplification testing can detect HIV-1 RNA 10-12 days after exposure.

OBJECTIVE

Provide Dallas County Public Health Department the ability to detect an AHI and maintain a three day turn-around-time for a reactive specimen.

STUDY

DESIGN

The population includes patients requesting HIV testing at various clinics throughout the state of Texas. Analyze various pool sizes for the pooling of specimens with the Aptima HIV-1 RNA qualitative assay to detect an acute HIV infection. Modify the HIV testing algorithm to include the detection of an acute HIV infection without delaying reporting results to original submitters. Perform a study to compare the detection of HIV in various HIV assays (3rd generation EIA assay, 4th generation EIA assay, HIV-1 RNA NAAT). Perform public health follow-up on patients who are confirmed to have an acute HIV infection with a goal of preventing the spread to uninfected partners.

RESULTS

A pooling protocol was validated and performed concurrently with the EIA to maintain a reactive result released after three days of collection. Of the 148,888 (2009-2012) specimens screened for HIV, 161 AHIs were detected and the public health follow-up identified an additional 13 new HIV infections that had been a contact to one of the AHIs.

CONCLUSION

Without the advancement in technology, patients could have received a negative or indeterminate test prior to implementing the NAAT, resulting in a delay in diagnosis and potential spread to uninfected partners. Improving the detection of an AHI is crucial in preventing the spread of the virus.