1. THE BODY PRO The HIV Resource for Health Care Professionals Copyright © 2009 The HealthCentral Network, Inc. All rights reserved. This activity is jointly sponsored by Postgraduate Institute for Medicine and The Body PRO. An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation Faculty: David Wohl, M.D. Associate Professor of Medicine at the University of North Carolina at Chapel Hill

2. The Body PRO An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation 1 Faculty for This Activity David Wohl, M.D. Dr. Wohl is an associate professor of medicine at the University of North Carolina at Chapel Hill, and co-directs HIV services for the North Carolina Department of Corrections. Dr. Wohl is an investigator in the NIAID-sponsored AIDS Clinical Trials Group (ACTG) and a member of the ACTG Complications of HIV Disease Research Agenda Committee. His research focuses on metabolic and infectious complications of HIV and its therapies, as well as issues related to medication adherence and access to care—particularly among incarcerated inmates with HIV infection. Disclosures Dr. Wohl has been a consultant for Abbott Laboratories, Tibotec and Merck & Co. He has served on speaker bureaus for Abbott, Gilead, Roche Laboratories, Bristol-Myers Squibb, Boehringer Ingelheim, Tibotec and Merck. In addition, he has received research support from Abbott, Roche and Merck. This activity is supported by an educational grant from

3. The Body PRO An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation 2 Estimated Number of New HIV Infections in the U.S., Overall and by Gender, 2006 From Centers for Disease Control and Prevention; August 2008. Reprinted with permission. Note: Because of rounding, estimates of subgroups do not add to total.

4. The Body PRO An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation 3 Estimated Number of New HIV Infections in the U.S., by Transmission Category, 2006 From Centers for Disease Control and Prevention; August 2008. Reprinted with permission.

5. The Body PRO An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation 4 Undiagnosed HIV Prevalence Rates in the U.S., 2006 Michael Campsmith et al. CROI 2009; abstract 1036. Reprinted with permission.

6. The Body PRO An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation 5 Estimated Prevalence of Undiagnosed HIV Infection in the United States at the End of 2006 Michael Campsmith et al. CROI 2009; abstract 1036. Reprinted with permission.

7. The Body PRO An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation 6 Michael Campsmith et al. CROI 2009; abstract 1036. Reprinted with permission. Estimated Prevalence of Undiagnosed HIV Infection in the United States at the End of 2006

8. The Body PRO An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation 7 Characteristics of Persons With HIV/AIDS Who Were Classified as Late and Early Testers*— 16 Sites, † United States, May 2000-February 2003 HIV Testing Late (N = 1,877)Early (N = 1,573) CharacteristicsNo.(%)No.(%) Crude Odds Ratio (95% CI § ) Sex Female465(25)390(25)1.0(0.9-1.2) Male1,412(75)1,183(75)Referent Age Group (yrs) (at HIV Diagnosis) 18-29202(11)93(6)1.7(1.3-2.4) 30-39693(37)606(39)0.9(0.7-1.1) 40-49702(37)653(42)0.9(0.7-1.1) ≥50280(15)221(14)Referent Race/Ethnicity ¶ White338(18)458(29)Referent Black1,045(56)791(50)1.8(1.5-2.1) Hispanic426(23)258(16)2.2(1.8-2.8) Mode of Exposure MSM**720(39)674(43)Referent IDU †† 234(13)354(23)0.6(0.5-0.8) MSM/IDU91(5)210(13)0.4(0.3-0.5) Heterosexual §§ 818(44)323(21)2.4(2.0-2.8) Level of Education < High School643(34)454(29)1.4(1.2-1.7) High School615(33)491(31)1.3(1.1-1.5) ≥ High School615(33)627(40)Referent Ever Tested Before the First Positive HIV Test? Yes704(38)368(23)2.0(1.7-2.3) No1,173(62)1,205(77)Referent From Centers for Disease Control and Prevention; December 2006. Reprinted with permission. *Late testers were defined as persons who had their first positive HIV test ≤1 year of diagnosis of AIDS; early testers were defined as persons who either had their first positive HIV test ≥5 years before the diagnosis of AIDS or had ≥5 years without a diagnosis of AIDS after their first positive HIV test. † Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Kansas, Maryland, Michigan, Minnesota, New Jersey, New Mexico, South Carolina, Texas and Washington. § Confidence interval. ¶ Numbers for racial/ethnic groups other than white, black and Hispanic were too small for meaningful analysis. **Men who have sex with men. †† Injection-drug user. §§ Heterosexual mode of exposure includes persons who had heterosexual contact with persons with identified risk, including heterosexual contact with known HIV-infected person, woman having sex with a bisexual man, or heterosexual contact with an IDU (N=190 [12%] of early testers and 381 [20%] of late testers), and persons who had heterosexual contact with persons with no known or identified risk (presumed transmission from heterosexual contact) (N=132 [8%] of early testers and 436 [23%] of late testers).

9. The Body PRO An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation 8 Percentage of Late and Early Testers,* by Reason for Testing—16 Sites, † United States, 2000-2003 *Late testers were defined as persons who had their first positive HIV test ≤1 year of diagnosis of AIDS; early testers were defined as persons who either had their first positive HIV test ≥5 years before the diagnosis of AIDS or had ≥5 years without a diagnosis of AIDS after their first positive HIV test. † Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Kansas, Maryland, Michigan, Minnesota, New Jersey, New Mexico, South Carolina, Texas and Washington. From Centers for Disease Control and Prevention; June 2003. Reprinted with permission.

10. The Body PRO An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation 9 Judy Chen et al. CROI 2009; abstract 1044. Reprinted with permission. HIV Testing and Monitoring in Privately Insured Members Recently Diagnosed With Suspected AIDS-Defining Events in the U.S. (1)

11. The Body PRO An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation 10 HIV Testing and Monitoring in Privately Insured Members Recently Diagnosed With Suspected AIDS-Defining Events in the U.S. (2) Judy Chen et al. CROI 2009; abstract 1044. Reprinted with permission.

12. The Body PRO An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation 11 Michael Campsmith et al. CROI 2009; abstract 1036. Reprinted with permission. Estimated Prevalence of Undiagnosed HIV Infection in the United States at the End of 2006

13. The Body PRO An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation 12 Number and Percentage of HIV-Infected Persons* With AIDS Subsequently Diagnosed Within One Year of HIV Diagnosis Who Had Visited a Health Care Facility Before Date of HIV Diagnosis, by Selected Characteristics—South Carolina, 2001-2005 From Centers for Disease Control and Prevention; December 2006. Reprinted with permission.

14. The Body PRO An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation 13 Number and Percentage of Health Care Visits by HIV-Infected Persons* With AIDS Subsequently Diagnosed Within One Year of HIV Diagnosis Who Had Visited a Health Care Facility Before Date of HIV Diagnosis, by Reported Diagnosis—South Carolina, 1997-2005 From Centers for Disease Control and Prevention; December 2006. Reprinted with permission.

15. The Body PRO An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation 14 Proportion of Visits Without HIV Test for Heterosexuals and MSM (2006-2007) Adapted from T Heijman et al. AIDS 2008; abstract TUPE0414. *Jan-07: Opt-out testing introduced

16. The Body PRO An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation 15 Routine Opt-Out HIV Testing Texas STD Clinics, 1996-1997 From Centers for Disease Control and Prevention; June 2006. Reprinted with permission.

17. The Body PRO An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation 16 Estimated Number of Cases of Perinatally Acquired AIDS by Year of Diagnosis — United States, 1985-2004 From Centers for Disease Control and Prevention; June 2006. Reprinted with permission.

18. The Body PRO An Evaluation of Routine HIV Testing and Its Impact on HAART Initiation 17 Current Status of Legislation to Change HIV Testing Laws in the United States No legislative restrictions at time of 2006 CDC recommendations Legislation enacted to reduce or eliminate prior restrictions Legislation introduced to remove requirement for a separate consent but not enacted or decision pending Restrictive legislation at time of CDC recommendations and no subsequent proposal to change legislation Adapted from John G. Bartlett et al. JAMA. 2008;300:945-951.