title: Towards targeted screening for acute HIV infections in British Columbia.
abstract: BACKGROUND
  Our objective was to describe the characteristics of acute and established HIV infections diagnosed in the Canadian province of British Columbia. Province-wide HIV testing and surveillance data were analyzed to inform recommendations for targeted use of screening algorithms to detect acute HIV infections.
  
  
  METHODS
  Acute HIV infection was defined as a confirmed reactive HIV p24 antigen test (or HIV nucleic acid test), a non-reactive or reactive HIV EIA screening test and a non-reactive or indeterminate Western Blot. Characteristics of unique individuals were identified from the British Columbia HIV/AIDS Surveillance System. Primary drug resistance and HIV subtypes were identified by analyzing HIV pol sequences from residual sera from newly infected individuals.
  
  
  RESULTS
  From February 2006 to October 2008, 61 individuals met the acute HIV infection case definition, representing 6.2% of the 987 newly diagnosed HIV infections during the analysis period. Acute HIV infection cases were more likely to be men who have sex with men (crude OR 1.71; 95% CI 1.01-2.89], to have had a documented previous negative HIV test result (crude OR 2.89; 95% CI 1.52-5.51), and to have reported a reason for testing due to suspected seroconversion symptoms (crude OR 5.16; 95% CI 2.88-9.23). HIV subtypes and rates of transmitted drug resistance across all classes of drugs were similar in persons with both acute and established HIV infections.
  
  
  CONCLUSIONS
  Targeted screening to detect acute HIV infection is a logical public health response to the HIV epidemic. Our findings suggest that acute HIV infection screening strategies, in our setting, are helpful for early diagnosis in men who have sex with men, in persons with seroconversion symptoms and in previously negative repeat testers.
authors.affiliation: British Columbia Centre for Disease Control, Vancouver, BC, Canada.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Steinberg
authors.forename: Darrel A
authors.initials: DA
authors.lastname: Cook
authors.forename: Mark
authors.initials: M
authors.lastname: Gilbert
authors.forename: Mel
authors.initials: M
authors.lastname: Krajden
authors.forename: Devon
authors.initials: D
authors.lastname: Haag
authors.forename: Peggy
authors.initials: P
authors.lastname: Tsang
authors.forename: Elsie
authors.initials: E
authors.lastname: Wong
authors.forename: James I
authors.initials: JI
authors.lastname: Brooks
authors.forename: Harriet
authors.initials: H
authors.lastname: Merks
authors.forename: Michael L
authors.initials: ML
authors.lastname: Rekart
mesh_terms: D000328:Adult; D000368:Aged; D000956:Antigens, Viral / Q000097:blood; D001955:British Columbia; D019411:Clinical Laboratory Techniques / Q000379:methods*; D024882:Drug Resistance, Viral; D042241:Early Diagnosis; D005260:Female; D005838:Genotype; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood / Q000235:genetics
chemical_list: D000956:Antigens, Viral; D012367:RNA, Viral