Online Program

Identifying Acute HIV Infections: Unexpected Benefit Of HIV Screening With A 4Th Generation Testing Platform

Tuesday, November 3, 2015

Michael Menchine, MD, MPH, USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA
Kathleen Jacobson, MD, Department of Family Medicine, Keck School of Medicine at USC, Los Angeles, CA
Chun Nok Lam, MPH, Department of Preventive Medicine, University of Southern California, Los Angeles, CA
Ira Shulman, MD, Department of Pathology, LAC+USC Medical Center, Los Angeles, CA
Sanjay Arora, MD, USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA
Background: Lab-based 4th generation testing platforms enhance emergency department (ED) HIV testing capacity by resulting tests in 1 hour. Additionally,, 4th generation testing can identify acute HIV infection within 14 days of exposure. This study evaluated the impact of a lab-based 4thgeneration ED screening program on the detection of acute HIV infection.

Methods: We conducted a retrospective review of the HIV testing program 15 months before and after converting from a point-of-care testing procedure to a lab-based 4thgeneration program (4/2012-9/2014). Our ED offers non-targeted testing of adult ED patients regardless of chief complaint. Acute HIV infection was defined as detectable HIV RNA or p24 antigen.

Results: HIV testing increased from 8,983 tests in the 15 months before the 4th generation testing to 22,593 in the 15 months after. Correspondingly, the number of newly diagnosed HIV+ individuals increased from 36 (0.4%) to 115 (0.5%). Zero acute HIV infections were identified prior to 4thgeneration testing while 14 acute HIV infections (12.2% of new infections) were diagnosed after. Acutely HIV-infected individuals had mean age of 34.8 years and 93% were male, 21.4% were African-American and 79% Latino. Median viral load in this group was 1.7 million copies/ml (3 cases had viral load >10 million copies/ml) and 85.6% of the patients attended at least one HIV-specific outpatient clinic visit.

Conclusion: Converting to a rapid, 4th generation HIV testing platform made critically-important acute HIV case identification feasible and resulted in identification of 14 acute cases in an urban ED setting.

Learning Areas:

Administer health education strategies, interventions and programs
Administration, management, leadership
Implementation of health education strategies, interventions and programs
Provision of health care to the public

Learning Objectives:
Evaluate the impact of a lab-based 4th generation emergency department HIV screening program on the detection of acute HIV infection

Keyword(s): Prevention, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the research project manager of this HIV testing program for the past four years. I received my master degree in public health, focusing on epidemiology and biostatistics. I am responsible for the data management, analysis and reporting of the HIV testing program to the local public health department.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.