Testing HIV-Ab Negative High Risk Individuals for HIV RNA Sally Liska, DrPH, Director San Francisco PH Laboratory February 28, 2005 Orlando, FL

Relationship Between HIV Infection and Other STI’s. 1. STD’s increase risk of transmission & acquisition of HIV. 2. Syphilis rates have been increasing in SF & Los Angeles in the past 5 years. 3. Prevalence of HIV infection in SF STD clinic (City Clinic) averages 3-5%.

SF Pilot Program to Detect Acute HIV Infection 1. Acute HIV infection is interval between infection and appearance of antibodies. 2. Provide clients with information – real time reporting. 3. Decision to pool specimens submitted for routine HIV screening [JAMA:2002, Vol. 288:2]. High viral load during acute phase Decrease cost

HIV Screening Algorithm HIV Ab EIA If EIA Neg then Pool for RNA testing If Pool is Neg report as RNA negative If Pool is + then test Individual samples If EIA + then do supplemental testing

SF Results Time period: Oct ‘03 – Dec ‘04 HIV Ab Testing ( bioMerieux Vironostika HIV-1) 4557 specimens 164 Ab positive (3.6%) HIV RNA Testing (Bayer Versant bDNA) 4126 specimens 17 RNA positive (0.41%)

Los Angeles Study Stored serum specimens from STD clinic clients. Testing was “unlinked”. Larger pool size (80-90 samples/pool) Vironostika HIV-1 EIA for Ab; Roche PCR for RNA Two RNA positive of 2939 Ab negative samples (.06%)

Conclusions RNA testing increased detection of acute HIV infection in high risk individuals. Pooling antibody negative specimens can be incorporated into a realtime HIV screening program. Knowledge of acute HIV infection improved partner counseling and referral service (PC&RS).

ACKNOWLEDGEMENTS Peter Kerndt Sydney Harvey Anthony Gonzales Anthony Mayr Kellie Hawkins Getahun Aynalem Melanie Taylor Lina Sy Lisa Smith Jeff Klausner Lyn Fischer Bob Kohn Charlotte Kent Brian Louie Ernie Wong John Lei Martha Obeso CC C&T staff