title: Short communication: Investigation of incident HIV infections among U.S. army soldiers deployed to Afghanistan and Iraq, 2001-2007.
abstract: The U.S. Army initiated an investigation in response to observations of a possible increase in HIV incidence among soldiers deployed to combat. Human immunodeficiency virus (HIV)-infected U.S. Army soldiers are not eligible to deploy. Combat presents a health hazard to HIV-infected soldiers and they pose a threat to the safety of the battlefield blood supply and their contacts. All soldiers are routinely screened for HIV every 2 years and those who deploy are also screened both prior to and after deployment. Seroconversion rates were estimated for all soldiers who deployed to Afghanistan or Iraq in the period 2001-2007 and all active duty soldiers who did not. Seroconverters with an estimated date of infection, based on calculation of the midpoint between the last seronegative and first seropositive test date, that was either before or during deployment were eligible for inclusion. Confidential interviews and medical record reviews were conducted to determine the most likely time, geographic location, and mode of infection. Reposed predeployment samples were tested for HIV ribonucleic acid. The HIV seroconversion rate among all soldiers who deployed was less than the rate among those who did not deploy: 1.04 and 1.42 per 10,000 person-years, respectively. Among 48 cases, most were determined to have been infected in the United States or Germany and prior to deployment (n=20, 42%) or during rest and relaxation leave (n=13, 27%). Seven seronegative acute infections were identified in the predeployment period. Subtype was determined for 40 individuals; all were subtype B infections. All were acquired through sexual contact. These findings can inform development of preventive interventions and refinement of existing screening policy to further reduce HIV-infected deployed soldier person time.
authors.affiliation: Walter Reed Army Institute of Research, U.S. Military HIV Research Program, Bethesda, Maryland, USA. pscott@hivresearch.org
authors.forename: Paul T
authors.initials: PT
authors.lastname: Scott
authors.forename: Shilpa
authors.initials: S
authors.lastname: Hakre
authors.forename: Otha
authors.initials: O
authors.lastname: Myles
authors.forename: Eric E
authors.initials: EE
authors.lastname: Sanders-Buell
authors.forename: Gustavo H
authors.initials: GH
authors.lastname: Kijak
authors.forename: Francine E
authors.initials: FE
authors.lastname: McCutchan
authors.forename: Robert J
authors.initials: RJ
authors.lastname: O'Connell
authors.forename: Sheila A
authors.initials: SA
authors.lastname: Peel
authors.forename: J Connor
authors.initials: JC
authors.lastname: Eggleston
authors.forename: Warren B
authors.initials: WB
authors.lastname: Sateren
authors.forename: Micaela
authors.initials: M
authors.lastname: Robb-McGrath
authors.forename: Robert L
authors.initials: RL
authors.lastname: Mott
authors.forename: Steven K
authors.initials: SK
authors.lastname: Tobler
authors.forename: Eileen
authors.initials: E
authors.lastname: Nolan
authors.forename: Bruno P
authors.initials: BP
authors.lastname: Petruccelli
authors.forename: Nelson L
authors.initials: NL
authors.lastname: Michael
authors.forename: Steven B
authors.initials: SB
authors.lastname: Cersovsky
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000635:transmission; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D054542:Iraq War, 2003-2011; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult