Buskin Susan E, Fida Neway G, Bennett Amy B, Golden Matthew R, Stekler Joanne D
Public Health -- Seattle & King County, Prevention Division, Seattle, WA, USA ; University of Washington, Department of Epidemiology, Seattle, WA, USA.
Public Health -- Seattle & King County, Prevention Division, Seattle, WA, USA.
Open AIDS J. 2014 Sep 30;8:45-9. doi: 10.2174/1874613601408010045. eCollection 2014.
The U.S. HIV staging system is being revised to more comprehensively track early and acute HIV infection (AHI). We evaluated our ability to identify known cases of AHI using King County (KC) HIV surveillance data.
AHI cases were men who have sex with men (MSM) with negative antibody and positive pooled nucleic acid amplification (NAAT) tests identified through KC testing sites. We used KC surveillance data to calculate inter-test intervals (ITI, time from last negative to first positive test) and the serologic algorithm for recent HIV seroconversion (STARHS). For surveillance data, AHI was defined as an ITI of ≤ 30 days and early infection as an ITI ≤ 180 days or STARHS recent result. Dates of last negative HIV tests were obtained from lab reports in the HIV surveillance system or data collected for HIV Incidence Surveillance.
Between 2005 and 2011, 47 MSM with AHI were identified by pooled NAAT. Of the 47 cases, 36% had ITI < 1 day, 60% had an ITI < 30 days, and 70% (95% CI=55-82%) had an ITI ≤ 6 months and would have been identified as early HIV infection. Of the 47, 38% had STARHS testing and 94% were STARHS recent.
MSM with known AHI were not identified by proposed definitions of AHI and early infection. These known AHI cases were frequently missed by HIV surveillance because concurrent negative antibody tests were not reported. Successful implementation of the revisions to the HIV staging system will require more comprehensive reporting.
美国的艾滋病毒分期系统正在修订，以更全面地追踪早期和急性艾滋病毒感染（AHI）。我们利用金县（KC）艾滋病毒监测数据评估了识别已知AHI病例的能力。
AHI病例为通过KC检测点确定的抗体阴性且混合核酸扩增（NAAT）检测呈阳性的男男性行为者（MSM）。我们利用KC监测数据计算检测间隔时间（ITI，从最后一次阴性检测到首次阳性检测的时间）以及近期艾滋病毒血清转化的血清学算法（STARHS）。对于监测数据，AHI定义为ITI≤30天，早期感染定义为ITI≤180天或STARHS近期结果。最后一次艾滋病毒阴性检测的日期从艾滋病毒监测系统的实验室报告或为艾滋病毒发病率监测收集的数据中获取。
2005年至2011年期间，通过混合NAAT确定了47例患有AHI的MSM。在这47例病例中，36%的ITI<1天，60%的ITI<30天，70%（95%CI=55-82%）的ITI≤6个月，这些病例本可被识别为早期艾滋病毒感染。在这47例中，38%进行了STARHS检测，94%的检测结果为STARHS近期。
根据提议的AHI和早期感染定义，未识别出已知患有AHI的MSM。艾滋病毒监测经常遗漏这些已知的AHI病例，因为未报告同时进行的阴性抗体检测。艾滋病毒分期系统修订版的成功实施将需要更全面的报告。
