Tests for New H.I.V. Infection Not Widely Adopted (AEGiS) -
Tests for New H.I.V. Infection Not Widely Adopted
The New York Times - May 1, 2009 David Tuller
http://www.aegis.org/news/nyt/2009/NYT090501.html

In December 2008, after a weekend of sex fueled by methamphetamine, Chris, a San Francisco man in his early 30s, sought out testing for sexually transmitted diseases at Magnet, a clinic serving homosexual men in the city's Castro neighborhood.
Staff members tested him for H.I.V. twice: first with a standard rapid test, which detects H.I.V. antibodies in saliva or a drop of blood, then with a blood test for genetic traces of the virus itself.
Although the antibody test can deliver immediate results, it is not likely to identify an infection that has occurred in the past month. The genetic test, which looks for bits of the virus's ribonucleic acid, or RNA, can identify infections in a week to 10 days. Chris, who asked that his full name not be used, was told that his antibody test was negative. But his RNA test was positive, making him one of the few whose diagnosis came in the acute, or primary, phase of infection, when the virus is replicating aggressively but the body has not yet mounted an effective immune response.
Many public health officials and AIDS experts increasingly see identification of the newly infected as an important next step in controlling the spread of H.I.V., the virus that causes AIDS. Yet the RNA test, the only one capable of detecting the newest infections, has not been widely adopted for this purpose.
"People with acute infection have more virus in the blood, and if they're unaware they're infected, they're more likely to engage in risky behavior," said Dr. Kenneth Mayer, a professor of medicine at Brown University and a leading AIDS researcher.
Finding those with new infections sooner and providing counseling will help prevent them from infecting others, Dr. Mayer said. As it stands, studies suggest that the recently infected could be the source of 10 percent to 50 percent of all new H.I.V. transmissions.
"We have a serious ongoing problem of H.I.V. transmission that hasn't been adequately addressed," said Dr. Jeffrey Klausner, director of S.T.D. prevention at the San Francisco Department of Public Health.
The Centers for Disease Control and Prevention has conducted pilot studies of RNA testing in some cities, but current national guidelines focus on more widespread antibody testing to identify some of the estimated 250,000 Americans who are infected but do not know it. Routine RNA testing has been tried rarely, in part because it is expensive, involves drawing blood and complicated laboratory work, and does not provide immediate results.
But health departments in North Carolina and San Francisco have used the tests in some settings for several years, reducing costs by pooling many blood samples and testing them together. Officials there have reported finding dozens of cases of acute infection that were not detected by the standard test, and they have advocated for much wider use of the RNA test.
The Magnet clinic began its RNA testing program last year to serve gay men who engage in unprotected sex and are in social and sexual networks at the highest risk of acquiring H.I.V. "Early detection is a prevention strategy," said Judy Auerbach, public policy director of the San Francisco AIDS Foundation, which runs the clinic.
Chris, the San Francisco man whose infection was diagnosed with an RNA test, said the early diagnosis had allowed him "to be more proactive, to get right on it at the start and feel a little bit more in control."
Reduction of H.I.V. transmission rates has taken on renewed urgency. Last year, the disease control agency raised its estimate for annual new H.I.V. infections to 56,000, from 40,000. In 2008, the agency reported that from 2001 to 2006, H.I.V. diagnoses increased annually by 15 percent among young African-American men who have sex with men.
A less expensive alternative to the RNA test may not be far away. The centers recently began a study to compare RNA testing with an advanced version of the standard test, which is easy to administer and can detect a substance produced by the virus in its early stages.
The newest test, called an antibody-antigen test, appears able to identify 85 percent of the acute H.I.V. infections picked up by the RNA test and could be commercially available next year, agency officials said.
090501 NYT090501

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