WEPE011 - Poster Exhibition
Early HIV infection and transmissions averted by early diagnosis among men who have sex with men in the United States
P. Patel, R. Wiegand, A. Hutchinson
Centers for Disease Control and Prevention, Atlanta, United States
Background: Early HIV infection (EHI) is the stage of infection prior to HIV seroconversion when individuals are highly infectious and at high-risk for HIV transmission. Data are limited about risk factors for EHI and transmissions averted by identifying EHI.
Methods: From April 2006 to March 2008, persons underwent routine HIV antibody screening followed by nucleic acid amplification testing (NAAT) at 96 municipal clinics in three U.S. cities. Specimens that were seronegative or indeterminate and NAAT-positive met the definition of EHI. Counseling and testing data were available for all HIV-positive persons. Consenting persons with EHI also completed a behavioral risk survey. We performed univariate analyses to characterize MSM with EHI and examined associated risk factors using robust Poisson regression analysis. We estimated HIV transmissions averted by EHI diagnosis using a published transmission model.
Results: Of 43,559 persons screened, 302 MSM were diagnosed with HIV, of whom 37 (12%) had EHI. Characteristics of MSM with EHI were: median age 29 years (interquartile range [IQR] 25-37), 57% Hispanic, 80% reported 1-3 sex partners in the last 30 days, 24% reported methamphetamine use, 14% had sexually transmitted infection, and 11% reported a negative HIV test (all in the last three months). In multivariate analysis, MSM with EHI were less likely to be non-Hispanic black (Risk Ratio [RR]=0.07, 95%CI: 0.01-0.05) and more likely to have a negative HIV test in the last three months (RR=2.7, 95%CI: 1.1-6.8) compared with MSM with established HIV infection. Early HIV diagnosis resulted in 4.2 transmissions averted assuming persons with EHI would have otherwise been diagnosed one year later.
Conclusions: Our findings suggest that there may be little utility for risk-based EHI screening among MSM in the U.S. Rather, frequent testing among MSM may be indicated to improve EHI detection which may reduce further HIV transmission.
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