Acute HIV Program: Testing, Diagnosis & Referral

1. Acute HIV Follow-Up in NCPresented by Muhammad “Maxi” Mackalo, DIS

2. Background of ACUTE HIV STAT: Screening and Testing for Active Transmission The program has been operating since 2002 Dr Leone, Medical Director, Communicable Disease Branch is one of the co-founders of the study and is currently superheading the program operation

3. Detection/Testing Tests are analyze at state-funded public health virology & serology laboratory; Serum specimen are tested using a method called pooling & nucleic-acid testing using ultrasensitive HIV RNA RT-PCR test; Results obtained are confirmed using WB; In 2002, 4.9 cases per 10,000 clients were identified as a case

4. Function of STAT/ACUTE Program • To detect acute HIV; • Notify, Counsel, & Interview client; • Assist them get into care; and • Notify, counsel, and test their partners

5. Symptoms Acute Retroviral syndrome (Mostly Flu-like symptoms) such as: Fever, rash, headache, night sweats, fatigue, malaise, athralgia, myalgia, pharyngitis, swollen lymph nodes, weight Loss (~ 6 lbs. or more), loss of appetite, oral ulcers, nausea, vomiting and diarrhea

6. Risk Factors Unprotected receptive & insertive anal sex; The sharing of IV drug paraphernalia ; Unprotected vaginal sex; Receptive oral sex with a male partner; Exposure to HIV/AIDS via any exchange of bodily fluids (ex: needle stick) .

7. Diagnosis All clients with (-) EIA (+) NAAT results, as well as EIA (+) WB (-) or Indeterminate with a (+) NAAT need to be followed by DIS for notification, counseling, interview & repeat HIV serology for confirmation of HIV infection Clients with a (-) HIV antibody test within the previous month followed by (+) EIA/WB test are also identified as acute HIV cases

8. Diagnosis Cont. • Community Acute: • Detected outside NCSLPH; and • Initial testing is performed by a PMD or another community clinic;

9. Identification of Comm. Acute • EIA/WB (-) and HIV RNA (+) • EIA(+), (Indeterminate / (-) WB) and a detectable HIV RNA PCR or Viral Load • EIA (+), (Indeterminate / (-) WB ) with a documented EIA/WB in past month • EIA (+), Indeterminate / (-) WB and a (+) EIA/WB within a month of Indeterminate test • EIA/WB (+) within a month of EIA/WB (-)

10. Identification of Comm. Recent • EIA/WB (+) and a documented EIA (-) within last 6 mths of initial positive test; • EIA (-) < 3 mths from date of first positive test; • Patient noted signs/sympt of acute retroviral syndrome < 1 mth from date of first positive test; and/or • Patient diagnosed/Rx’d for an STD < 1 mth from date of first positive test

11. Referral Persons identified with acute HIV are offered immediate access to care via the Acute HIV Program @ UNC Statewide network of providers Medical Evaluation and assessment by a clinician familiar with acute HIV infection Receive information about HIV & acute HIV infection Financial, social & psychological assistance available Discuss concern(s) with diagnosis and treatment Provide information for care options and applicable research opportunities

12. DIS Duties/Responsibilities Locate, Notify, Counsel, Interview, and draw repeat specimen Transport to first medical visit Contact tracing for partners & suspects within 72 hours Schedule follow up visits within a week after interview with all clients Additional STAT research program - 1. Obtain consent to allow initial blood samples to go to UNC for testing 2. HIPAA release form to discuss sexual -social networks for state epidemiology and outbreak information

13. Acknowledgement: Many thanks to the following in preparation of this presentation: Todd Vanhoy: NC Field Service Mgr. Rhonda Ashby: Asst. Field Service Mgr. Dr. Peter Leone: NC Medical Director, Communicable Disease Branch Joann Kuruc: Acute HIV Program Mgr.