Detecting acute human immunodeficiency virus infection using 3 different screening immunoassays and nucleic acid amplification testing for human immunodeficiency virus RNA, 2006-2008.
BACKGROUND
The yield of nucleic acid amplification testing (NAAT) after routine screening for human immunodeficiency virus (HIV) antibody to detect acute HIV infection (AHI) may vary with different HIV-antibody assays.


METHODS
From April 24, 2006, through March 28, 2008, patients underwent routine HIV-antibody screening using a first-generation assay at 14 county sexually transmitted disease (STD) clinics and 1 community clinic serving homosexual patients in Los Angeles; using a second-generation rapid test at 3 municipal STD clinics in New York; and using a third-generation assay at 80 public health clinics in Florida. To identify AHI, seronegative specimens were pooled for NAAT, followed by individual NAAT of specimens with positive findings. All AHI samples screened by first- and second-generation assays also underwent third-generation testing.


RESULTS
We screened 37 012 persons using NAAT after first-generation testing; 35 AHIs were identified, increasing HIV case detection by 8.2%. After a second-generation rapid test, 6547 persons underwent NAAT; 7 AHIs were identified, increasing HIV case detection by 24.1%. After third-generation testing, 54 948 persons underwent NAAT; 12 AHI cases were identified, increasing HIV case detection by 1.4%. Overall, pooled NAAT after negative third-generation test results detected 26 AHI cases, increasing HIV case detection by 2.2%. Most of the AHI cases from Los Angeles (26 of 35 [74%]) were identified at the community clinic where NAAT after third-generation testing increased HIV case detection by 11.9%.


CONCLUSIONS
Pooled NAAT after third-generation testing increases HIV case detection, especially in venues of high HIV seropositivity. Therefore, targeted AHI screening using pooled NAAT after third-generation testing may be most effective, warranting a cost-benefit analysis.
Patel
Pragna
P
Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. plp3@cdc.gov
Mackellar
Duncan
D
Simmons
Pat
P
Uniyal
Apurva
A
Gallagher
Kathleen
K
Bennett
Berry
B
Sullivan
Timothy J
TJ
Kowalski
Alexis
A
Parker
Monica M
MM
LaLota
Marlene
M
Kerndt
Peter
P
Sullivan
Patrick S
PS
D015492:AIDS Serodiagnosis / Q000379:methods*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005431:Florida / Q000453:epidemiology; D015483:HIV Antibodies / Q000097:blood*; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007118:Immunoassay / Q000379:methods*; D015141:Los Angeles / Q000453:epidemiology; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D021141:Nucleic Acid Amplification Techniques / Q000379:methods*; D015995:Prevalence; D011933:Reagent Kits, Diagnostic; D012680:Sensitivity and Specificity; D015229:Sexually Transmitted Diseases, Viral / Q000175:diagnosis*
D015483:HIV Antibodies; D011933:Reagent Kits, Diagnostic