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Date Posted: 19:44:07 07/24/02 Wed
Author: moonotter
Subject: Specimen Pooling Feasible for HIV Screening

Specimen Pooling Feasible for HIV Screening


Laurie Barclay, MD
Medscape Medical News 2002. © 2002 Medscape


July 9, 2002 — Routine screening for acute infection with HIV in a low-risk population is feasible using blood specimen pooling and nucleic acid testing, according to a report in the July 10 issue of The Journal of the American Medical Association. The findings were also presented on July 6 at the XIV International AIDS Conference in Barcelona, Spain.
"The acute stage of the infection is almost never diagnosed in clinical practice and is always missed by routine antibody tests," lead author Christopher D. Pilcher, MD, from the University of North Carolina School of Medicine in Chapel Hill, says in a news release. "Without this type of testing, we miss the time when we know that people have by far the most virus in their blood and are at their most infectious. If we can catch infected people during the first weeks when routine antibody tests are still negative, we can help them avoid spreading HIV to their husbands, wives, unborn children, or other intimate partners."

This study tested 8,505 subjects seen at 110 publicly funded testing sites in North Carolina for routine HIV testing and counseling in August and December of 2001. Serum specimens negative by HIV enzyme immunoassay were screened in pools using an ultrasensitive HIV RNA reverse transcriptase-polymerase chain reaction (PCR) assay. Screening all specimens required 147 HIV RNA tests. Confirmatory testing reclassified results for individual HIV RNA-positive specimens as true- or false-positives.

"The reason this wasn't done before was that there are extraordinary difficulties in doing this kind of collaborative research effort in clinical public health settings," Pilcher says. "That we were able to do it is a credit not only to the UNC faculty and staff involved, but also to the people at the state's department of health and laboratory of public health who have shown an ability to think outside the box with regard to HIV."

Of the 8,194 subjects who had not previously tested positive for HIV and who also had sufficient serum for additional evaluation, 39 had long-term HIV infection (prevalence, 47.6 per 10,000 individuals at risk; 95% confidence interval [CI], 33.8-65.0 per 10,000).

Of the 8,155 individuals at risk with negative antibody tests, five were positive for HIV RNA, including four women with true-positive acute infection (prevalence, 4.9 per 10,000; 95% CI, 1.3-12.5 per 10,000). Two of these women developed symptoms consistent with an acute retroviral syndrome in the week after testing. Overall specificity of this screening strategy was 0.999.

"The nucleic acid testing, or PCR, detects patients who may represent a public health threat and who would ordinarily get a falsely reassuring 'negative' test result. We hope that this type of testing can help us cut the risk for the unsuspecting partners of acutely infected patients," Pilcher says.

Increased costs of this testing would be about $2 per test, or $4,109 for each new case diagnosed, which may be a small price to pay to prevent further HIV transmission or begin treatment earlier when it is most effective. "These people can potentially benefit themselves if we know to start them quickly and aggressively on antiretroviral treatment," Pilcher says. "Several very exciting but preliminary studies have shown recently that early treatment in this way may improve their long-term prognosis."

JAMA. 2002;288(2):216-221

Reviewed by Gary D. Vogin, MD






Laurie Barclay, MD, is a staff writer with WebMD.

Medscape Medical News is edited by Deborah Flapan, an associate editor at Medscape. Please send press releases and comments to news@webmd.net.
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