Acute HIV diagnosis missed in more than half of Southeastern US group

Acute HIV diagnosis missed in more than half of Southeastern US group

By Mark Mascolini on behalf of the International AIDS Society

      Fewer than half of adults identified with acute HIV infection in a southeastern US study group got diagnosed at their first healthcare visit with HIV, according to results of a 155-person study. Reflecting the HIV epidemic across the United States, many newly infected people were young Black men who have sex with men (MSM).

     In 1998 HIV researchers at Duke University and the University of North Carolina established the Duke-UNC AHI (acute HIV infection) Research Consortium Cohort to study acute infection in adults in the region. Cohort members must have a positive nucleic acid amplification test (NAAT) and either a negative enzyme immunoassay (EIA) test or a positive EIA with a negative or indeterminate Western blot.

     From 1998 through 2010, the Duke-UNC team enrolled 155 people with acute infection, 81 of them (52 percent) African American, 63 (41 percent) non-Hispanic white, 137 (88 percent) men, 18 women, and 108 (70 percent) MSM(Men having Sex with Men).

     Median age of the study group was 27 years (interquar-tile range [IQR] 22 to 38). Most cohort members—138 of 155 (89 percent)—reported acute infection symptoms that lasted for a median 17.5 days (IQR 22 to 38). Median nadir CD4 count stood at 408 cells/µL (IQR 289 to 563) and median observed peak viral load at 726,859 copies/mL (IQR 167,585 to 3,565,728).

     Among 152 cohort members with available data, the emergency room was the most frequent site of initial medical contact, in 55 people (36 per-cent). Among 137 people with available data, only 62 (45 percent) had acute HIV infection diagnosed at their first medical contact after becoming infected.

     The researchers note that the demographics of the study group “reflect the epidemic of this geographic area with a high proportion of African-Americans, including young Black MSM.” They also observe that women make up a small fraction of the study group, although women account for a growing proportion of HIV-positive people in the region.

     Source: Mehri S. McKellar, Anna B. Cope, Cynthia L. Gay, Kara S. McGee, JoAnn D. Kuruc, Melissa G. Kerkau, Christopher B. Hurt, Susan A. Fiscus, Guido Ferrari, David M. Margolis, Joseph J. Eron, Charles B. Hicks, and the Duke-UNC Acute HIV Infection Consortium. Acute HIV-1 infection in the southeastern United States: a cohort study. AIDS Research and Human Retroviruses. 2013; 29: 121-128.