New test being launched to pin new HIV cases
New STARHS test will clarify problem areas
Prevention researchers presented a sobering picture of the challenges that remain in reducing HIV transmission and increasing HIV testing and treatment at the 2003 National HIV Prevention Conference recently held in Atlanta. While officials unveiled details of a new HIV diagnosis test, investigators also pointed to several problem areas, including these:
- Youths, and teen-agers in particular, have had increases in HIV infections due to injection drug use (IDU) in the last few years in at least 25 states. That reverses the general steep decline in IDU-related HIV diagnoses in the United States.1
- HIV diagnoses among men who have sex with men (MSM), also within 25 states that long have reported HIV diagnoses, have increased significantly.
- African-American men and women are less likely than whites to realize that there are life-prolonging HIV antiretroviral treatments available. One study also shows that at-risk African-American women are both unaware of their own risk for HIV and are unwilling to be tested for the virus.2,3
The chief positive news presented at the Center for Disease Control and Prevention (CDC)-sponsored conference was the introduction of the Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS), which will be used at 35 testing sites that cover an area that accounts for an estimated 93% of the annual HIV infections in the United States.
"This system is expected to provide our clearest picture yet of the magnitude of the HIV epidemic, and it will propel us toward a greater understanding of the incidence of new HIV infections," said Robert Janssen, MD, a director in the Division of HIV/AIDS Prevention of the CDC. Janssen, who spoke about STARHS at the CDC conference, was the lead scientist in development of the STARHS technology.
STARHS, using a detuned assay, will be performed on blood samples that test positive for HIV through standard HIV tests. Since the detuned assay is unable to detect HIV antibodies at the low concentrations that are detected by standard HIV tests, it can be assumed that any blood sample that tests positive for HIV on the enzyme immunoassay or Western blot test, but does not test positive on the detuned assay, is one in which a recent infection has occurred, Janssen explained.
The technology is 95% accurate, and while it is less useful as a clinical treatment tool, it is a good way to assess trends in a large population base, he said.
Also, STARHS will solve the CDC’s problem with obtaining accurate statistics about new infection rates across the United States. Although 25 states have collected HIV diagnoses since the early-to-mid 1990s, the CDC continues to be reluctant to use these data because they are considered either incomplete or based on a progression rate of HIV to AIDS, which has changed.
So with STARHS, the CDC and local public health departments will be able to collect very useful, accurate information about who is becoming infected, where new infections are occurring, and ultimately, which populations are being most impacted.
"In fact, the impact of the new system on our nation’s HIV prevention efforts is expected to be profound," Janssen said. "With these data, the CDC will be able to develop more accurate data of new HIV infections, which is an important step toward understanding where the epidemic is headed."
Moreover, state and local health departments will be able to use the information to better target prevention efforts on whichever populations currently appear to be at highest risk for HIV infection, he added.
STARHS data, which are expected to be available in 2005, could not come too soon for the prevention community, which is coping with worrisome HIV/AIDS trends. Ronald Valdiserri, MD, MPH, deputy director of the National Center for HIV, STD, and TB Prevention at the CDC, said recent studies show that among some populations there may be an HIV resurgence.
"According to new data, HIV diagnoses among gay and bisexual men in some states increased by 7.1% in 2001 and 2002, and this is the third annual increase reported," he said. "Since the low point in 1999, HIV diagnoses among gay and bisexual men has risen by 17.7%."
The statistics come from the 25 states that have been collecting HIV diagnoses since the 1990s, Valdiserri added. "So HIV increases among gay and bisexual men adds to our growing concern about a resurgence in HIV among this population."
Likewise, CDC officials are concerned about an increase in new HIV diagnoses due to IDU among youth and young adults. Data show that between 2000 and 2001, IDU-related HIV diagnoses increased among 13- to 29-year-olds, and youth 19 years and younger than showed the greatest increase. Specifically, CDC data from the 25 HIV-reporting states show that HIV diagnoses among IDUs, ages 13-29, increased 15% from 2000 to 2001, after a 58% decline from 1994 to 2000.1
This underscores the continuing need to target HIV prevention and drug treatment programs to young people, Valdiserri said.
Minority populations require new focus
Two major studies presented at the conference suggest that prevention, testing, and treatment efforts aimed at minority populations need renewed focus and resources.
One CDC study shows that 19.1% of African Americans and 22% of Latinos are unaware that antiretroviral treatments are available to prolong the lives of people with HIV infection.2
"The disparity was even greater in some states where up to one-third of the people didn’t know there was treatment to prolong the life of people with HIV," said Shahul Ebrahim, MD, MSc, PhD, senior service fellow and behavioral scientist with the Prevention Research Branch of the Division of HIV/AIDS Prevention — Intervention Research and Support at the CDC.
Another study found that 73% of 308 African-American women surveyed in a Dallas family clinic did not believe they were at risk for HIV infection, despite the fact that more than half had a history of other sexually transmitted diseases (STDs).3 Also, the study found that many of the 159 women in the study who had a history of STDs reported inconsistent condom use and had multiple sexual partners. About 75% of these women did not believe they were at risk for HIV infection, and 60% of all of the women surveyed declined to have a free HIV test, which would not have required an additional blood draw.3
References
1. Glynn K. HIV diagnoses associated with injection drug use among young adults, United States, 1994-2001. Presented at the 2003 National HIV Prevention Conference. Atlanta; July 2003. Presentation #M1-B1001.
2. Ebrahim S. Race-related knowledge-gap about treatment for HIV/AIDS, United States 2001. Presented at the 2003 National HIV Prevention Conference. Atlanta; July 2003. Presentation #TP-079.
3. Shehan D, Waits R, Lipsky S, et al. Personal risk perception for HIV infection among young African-American women with a history of STD in Dallas County — Dallas Young Women’s Survey (1999-2000). Presented at the 2003 National HIV Prevention Conference. Atlanta; July 2003. Presentation #M2-A0302.
Prevention researchers presented a sobering picture of the challenges that remain in reducing HIV transmission and increasing HIV testing and treatment at the 2003 National HIV Prevention Conference recently held in Atlanta.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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