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Bernard M. Branson, M.D.
Associate Director for Laboratory DiagnosticsDivisions of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
HIV Testing andConsiderations for Prevention
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Percent of Persons Ever Tested and Percent of Persons Ever Tested and Tested in the Preceding 12 Months Tested in the Preceding 12 Months
- NHIS 2002-2006- NHIS 2002-2006
0
10
20
30
40
50
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Perc
ent
Ever tested Preceding 12 months
- MMWR August 8, 2008
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Early Indications of Progress:National Health Interview
SurveyEver Tested Last 12 months
2005 70,036,336 (39.9%)
18,042,610 (10.44%)
2006 71,468,420 (40.4%)
17,775,006 (10.39%)
2007 73,848,002 (41.3%)
18,791,895 (10.67%)
2008 80,172,602 (44.6%)
19,055,402 (10.74%)
Change since 2006:
8.7 million 1.3 millionSource: National Health Interview
Survey
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Estimated Cases of HIV/AIDS, by year of diagnosis
(based on 34 States with Confidential HIV Reporting)
2004 37,164
2005 36,640
2006 37,193
2007
Change:
42,655
5462 (15%)
Source: HIV/AIDS Surveillance Report, 2007
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CDC’s Expanded Testing Initiative
Test 1.5 million persons per year among populations disproportionately affected by HIV, primarily African-Americans.
Identify 20,000 new HIV infections
Funded September 2007
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Progress: Total Tests
Cumulative Tests
Avg Tests/Month
Oct-Mar 2008 87,038 14,506
Apr-Sept 2008 446,503 37,209
Oct – Mar 2009 859,882 47,771
April 2009 932,157 49,061
May 2009 1,027,059 51,353
June 2009 1,136,067 54,098
July 2009 1,221,680 55,531
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Percentage of Tests and New HIV+ Tests
by Venue, Sept 2007 through March 2009
34
1.4 1
26
13
1.1 1.2
18
5.3
39
1 0.7
22
14
0.9 0.7
16
5.6
05
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are
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Cor
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Sub
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TB
Clin
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Oth
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Per
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f T
ests
Total Tests HIV+ Tests
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HIV Testing Among IDU
HIV Testing Survey, 1998-1999• 90% previously tested
5 cities, 1998 – 2002*
• 93% previously tested• 69% tested within previous year
- Kellerman et el, JAIDS 2002- Heimer et al, AJPH 2007
*Chicago IL, Hartford CT, New Haven CT, Oakland CA, Springfield MA
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HIV Testing Among MSM
Young MSM study, 1998-2000• 88% previously tested, 54% in previous year
National HIV Behavioral Surveillance 2003-2005:• 92% previously tested, 77% in previous year
57,131 MSM visits to STD clinics, Denver, DC, San Francisco, Seattle• 94% previously tested• Median inter-test interval 243 days
- MacKellar et al, Sex Transm Diseases 2006 - CDC, MMWR Surveillance Summaries 2006 -Helms et al, JAIDS 2009
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Total Tested
HIVPrevalence
No. %
Unrecognized HIV Infection
No. %Age Group (yrs) 18-24 410 57 (14) 45 (79)25-29 303 53 (17) 37 (70)30-39 585 171 (29) 83 (49)40-49 367 137 (37) 41 (30) ≥ 50 102 32 (31) 11 (34)
Race/EthnicityWhite 616 127 (21) 23 (18)Black 444 206 (46) 139 (67)Hispanic 466 80 (17) 38 (48)Multiracial 86 16 (19) 8 (50)Other 139 18 (13) 9 (50)
Total 1,767 450 (25) 217(48)
HIV Prevalence and Proportion of Unrecognized HIV Infection Among 1,767 MSM, by Age Group and Race/Ethnicity
NHBS, Baltimore, LA, Miami, NYC, San Francisco
MMWR June 24, 2005
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Pooled RNA Screening for Acute HIV Infection
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1 Master Pool
1-Stage Pooling
16 Specimens A B C D E F G H I J
CDC Acute HIV Infection Study
K L M N O P
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Yield from Pooled RNA Screening after EIA
SiteNumber tested
HIV Ab+
RNA+/ Ab-
Florida – 2006-08
54,948 663 (1.2%)† 9 (0.02%)
L.A. - 2006-08
37,012 427 (1.2%)* 35 (0.09%)
†Screened with Bio-Rad 1-2 Plus O *Screened with Vironostika EIA
- Patel et al, CDC , Archives Int Med 2010
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Yield from Pooled RNA Screening after EIA
SiteNumber tested
HIV Ab+
RNA+/ Ab-
Florida – 2006-08
54,948 663 (1.2%)† 9 (0.02%)
L.A. - 2006-08
37,012 427 (1.2%)* 35 (0.09%)
L.A. - 2006-08
37,012 441 (1.2%)† 18 (0.05%)
†Screened with Bio-Rad 1-2 Plus O *Screened with Vironostika EIA
- Patel et al, CDC , Archives Int Med 2010
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Yield from Pooled RNA Screening after Rapid Test
SiteNumber tested
HIV Ab+
RNA+/ Ab-
Florida 604 17 (2.8%) 1 (0.2%)
New York 6,547 29 (0.4%) 7 (0.1%)
- Patel et al, CDC , Archives Int Med 2010
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Yield from Pooled RNA Screening after Rapid Test
SiteNumber tested
HIV Ab+
RNA+/ Ab-
Florida 604 17 (2.8%)* 1 (0.2%)Florida 604 17 (2.8%) † 1 (0.2%)
New York 6,547 29 (0.4%)* 7 (0.1%)
New York 6,547 35 (0.5%) † 1 (0.02%)
* Screened with OraQuick †Screened with BioRad 1-2 Plus O
- Patel et al, CDC , Archives Int Med 2010
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Acute HIV Screening: 99,111 tested
EIA-RR/WB+ 1,136 (1.1%)
NAAT+ 1,094 (96.3%)
NAAT- 42 (3.7%)
EIA-RR/WB-ind 30 (0.03%)
NAAT+ 3 (10.0%)
NAAT- 27 (90.0%)
EIA-neg/NAAT+ 52 (0.05%)
Acute HIV 48 (92%)
False-pos NAAT
4 (8%)
- Patel et al, Archives Int Med 2010
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Acute HIV Screening: 99,111 tested
EIA-RR/WB+ 1,136 (1.1%)
NAAT+ 1,094 (96.3%)
NAAT- 42 (3.7%)
EIA-RR/WB-ind 30 (0.03%)
NAAT+ 3 (10.0%)
NAAT- 27 (90.0%)
EIA-neg/NAAT+ 52 (0.05%)
Acute HIV 48 (92%)
False-pos NAAT
4 (8%)
- Patel et al, Archives Int Med 2010
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Acute HIV Screening: 99,111 tested
EIA-RR/WB+ 1,136 (1.1%)
NAAT+ 1,094 (96.3%)
NAAT- 42 (3.7%)
EIA-RR/WB-ind 30 (0.03%)
NAAT+ 3 (10.0%)
NAAT- 27 (90.0%)
EIA-neg/NAAT+ 52 (0.05%)
Acute HIV 48 (92%)
False-pos NAAT
4 (8%)
- Patel et al, Archives Int Med 2010
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Acute Infections in MSM detected by NAAT
0.3% of 14,005 frequently tested MSM in Seattle STD clinic; represent 20% of all HIV infections detected
26 (74%) of 35 AHI cases detected in LA at MSM clinic; 25% of all HIV infections detected
0.08% of 21,425 STD clinic patients in New York City; represent 9% of all HIV infections detected; 94% were MSM
- Stekler et al, Clin Infect Dis 2009
- Shepard et al, MMWR 2009- Patel et al, Archives Int Med 2010
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4th Generation vs. RNA
RNA+/ 3rd gen-negative specimens detected by 4th generation EIA:
• 38 of 46 (83%) – Australia*• 10 of 14 (71%) – CDC AHI study**• 51 of 61 (84%) – CDC panel***
• 4 days after RNA – 9 seroconversion panels***
* Cunningham P, HIV Diagnostics Conf 2007 ** Patel P, CROI 2009*** Owen M, CROI 2009
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Potential Prevention Research Questions
Indications for and frequency of retesting
Role of acute infection in sustaining the epidemic
Community trial of structured serosorting intervention