title: Finding those at risk: acute HIV infection in Newark, NJ.
abstract: BACKGROUND
  A screening strategy combining rapid HIV-1/2 (HIV) antibody testing with pooled HIV-1 RNA testing increases identification of HIV infections, but may have other limitations that restrict its usefulness to all but the highest incidence populations.
  
  
  OBJECTIVE
  By combining rapid antibody detection and pooled nucleic acid amplification testing (NAAT) testing, we sought to improve detection of early HIV-1 infections in an urban Newark, NJ hospital setting.
  
  
  METHODS
  Pooled NAAT HIV-1 RNA testing was offered to emergency department patients and outpatients being screened for HIV antibodies by fingerstick-rapid HIV testing. For those negative by rapid HIV and agreeing to NAAT testing, pooled plasma samples were prepared and sent to the University of Washington where real-time reverse transcription-polymerase chain reaction (RT-PCR) amplification was performed.
  
  
  RESULTS
  Of 13,226 individuals screened, 6381 had rapid antibody testing alone, and 6845 agreed to add NAAT HIV screening. Rapid testing identified 115 antibody positive individuals. Pooled NAAT increased HIV-1 case detection by 7.0% identifying 8 additional cases. Overall, acute HIV infection yield was 0.12%. While males represent only 48.1% of those tested by NAAT, all samples that screened positive for HIV-1 RNA were obtained from men.
  
  
  CONCLUSIONS
  HIV-1 RNA testing of pooled, HIV antibody-negative specimens permits identification of recent infections. In Newark, pooled NAAT increased HIV-1 case detection and provided an opportunity to focus on treatment and prevention messages for those most at risk of transmitting infection. Although constrained by client willingness to participate in testing associated with a need to return to receive further results, use of pooled NAAT improved early infection sensitivity.
authors: UMDNJ - Robert Wood Johnson Medical School, Somerset, NJ, United States(1). Electronic address: martineu@rwjms.rutgers.edu.
authors: Eugene G
authors: EG
authors: Martin
authors: UMDNJ - Robert Wood Johnson Medical School, Somerset, NJ, United States(1).
authors: Gratian
authors: G
authors: Salaru
authors: UMDNJ - New Jersey Medical School, Newark, NJ, United States.
authors: Debbie
authors: D
authors: Mohammed
authors: University of Washington, Seattle, WA, United States.
authors: Robert W
authors: RW
authors: Coombs
authors: New Jersey State Department of Health, Trenton, NJ, United States.
authors: Sindy M
authors: SM
authors: Paul
authors: UMDNJ - Robert Wood Johnson Medical School, Somerset, NJ, United States(1).
authors: Evan M
authors: EM
authors: Cadoff
mesh_terms: D000465:Algorithms; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000821:virology; D015497:HIV-1 / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007118:Immunoassay / Q000379:methods; D008297:Male; D009515:New Jersey; D021141:Nucleic Acid Amplification Techniques / Q000379:methods; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000379:methods*; D013997:Time Factors
keywords: HIV screen; HIV seronegativity; HIV testing algorithms; NAAT; Nucleic acid amplification tests; Rapid HIV tests
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