Performance of risk-based criteria for targeting acute HIV screening in San Francisco.
<h4>Background</h4>Federal guidelines now recommend supplemental HIV RNA testing for persons at high risk for acute HIV infection. However, many rapid HIV testing sites do not include HIV RNA or p24 antigen testing due to concerns about cost, the need for results follow-up, and the impac...
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Public Library of Science (PLoS)
2011
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oai:doaj.org-article:aa1f037c5eaa42588eeadf71b351fea72021-11-18T06:50:41ZPerformance of risk-based criteria for targeting acute HIV screening in San Francisco.1932-620310.1371/journal.pone.0021813https://doaj.org/article/aa1f037c5eaa42588eeadf71b351fea72011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21755003/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Federal guidelines now recommend supplemental HIV RNA testing for persons at high risk for acute HIV infection. However, many rapid HIV testing sites do not include HIV RNA or p24 antigen testing due to concerns about cost, the need for results follow-up, and the impact of expanded venipuncture on clinic flow. We developed criteria to identify patients in a municipal STD clinic in San Francisco who are asymptomatic but may still be likely to have acute infection.<h4>Methods</h4>Data were from patients tested with serial HIV antibody and HIV RNA tests to identify acute HIV infection. BED-CEIA results were used to classify non-acute cases as recent or longstanding. Demographics and self-reported risk behaviors were collected at time of testing. Multivariate models were developed and preliminarily evaluated using predictors associated with recent infection in bivariate analyses as a proxy for acute HIV infection. Multivariate models demonstrating ≥70% sensitivity for recent infection while testing ≤60% of patients in this development dataset were then validated by determining their performance in identifying acute infections.<h4>Results</h4>From 2004-2007, 137 of 12,622 testers had recent and 36 had acute infections. A model limiting acute HIV screening to MSM plus any one of a series of other predictors resulted in a sensitivity of 83.3% and only 47.6% of patients requiring testing. A single-factor model testing only patients reporting any receptive anal intercourse resulted in 88.9% sensitivity with only 55.2% of patients requiring testing.<h4>Conclusions</h4>In similar high risk HIV testing sites, acute screening using "supplemental" HIV p24 antigen or RNA tests can be rationally targeted to testers who report particular HIV risk behaviors. By improving the efficiency of acute HIV testing, such criteria could facilitate expanded acute case identification.Shelley N FacenteChristopher D PilcherWendy E HartogensisJeffrey D KlausnerSusan S PhilipBrian LouieKaterina A ChristopoulosTeri DowlingGrant N ColfaxPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 7, p e21813 (2011) |
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DOAJ |
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EN |
| topic |
Medicine R Science Q |
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Medicine R Science Q Shelley N Facente Christopher D Pilcher Wendy E Hartogensis Jeffrey D Klausner Susan S Philip Brian Louie Katerina A Christopoulos Teri Dowling Grant N Colfax Performance of risk-based criteria for targeting acute HIV screening in San Francisco. |
| description |
<h4>Background</h4>Federal guidelines now recommend supplemental HIV RNA testing for persons at high risk for acute HIV infection. However, many rapid HIV testing sites do not include HIV RNA or p24 antigen testing due to concerns about cost, the need for results follow-up, and the impact of expanded venipuncture on clinic flow. We developed criteria to identify patients in a municipal STD clinic in San Francisco who are asymptomatic but may still be likely to have acute infection.<h4>Methods</h4>Data were from patients tested with serial HIV antibody and HIV RNA tests to identify acute HIV infection. BED-CEIA results were used to classify non-acute cases as recent or longstanding. Demographics and self-reported risk behaviors were collected at time of testing. Multivariate models were developed and preliminarily evaluated using predictors associated with recent infection in bivariate analyses as a proxy for acute HIV infection. Multivariate models demonstrating ≥70% sensitivity for recent infection while testing ≤60% of patients in this development dataset were then validated by determining their performance in identifying acute infections.<h4>Results</h4>From 2004-2007, 137 of 12,622 testers had recent and 36 had acute infections. A model limiting acute HIV screening to MSM plus any one of a series of other predictors resulted in a sensitivity of 83.3% and only 47.6% of patients requiring testing. A single-factor model testing only patients reporting any receptive anal intercourse resulted in 88.9% sensitivity with only 55.2% of patients requiring testing.<h4>Conclusions</h4>In similar high risk HIV testing sites, acute screening using "supplemental" HIV p24 antigen or RNA tests can be rationally targeted to testers who report particular HIV risk behaviors. By improving the efficiency of acute HIV testing, such criteria could facilitate expanded acute case identification. |
| format |
article |
| author |
Shelley N Facente Christopher D Pilcher Wendy E Hartogensis Jeffrey D Klausner Susan S Philip Brian Louie Katerina A Christopoulos Teri Dowling Grant N Colfax |
| author_facet |
Shelley N Facente Christopher D Pilcher Wendy E Hartogensis Jeffrey D Klausner Susan S Philip Brian Louie Katerina A Christopoulos Teri Dowling Grant N Colfax |
| author_sort |
Shelley N Facente |
| title |
Performance of risk-based criteria for targeting acute HIV screening in San Francisco. |
| title_short |
Performance of risk-based criteria for targeting acute HIV screening in San Francisco. |
| title_full |
Performance of risk-based criteria for targeting acute HIV screening in San Francisco. |
| title_fullStr |
Performance of risk-based criteria for targeting acute HIV screening in San Francisco. |
| title_full_unstemmed |
Performance of risk-based criteria for targeting acute HIV screening in San Francisco. |
| title_sort |
performance of risk-based criteria for targeting acute hiv screening in san francisco. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2011 |
| url |
https://doaj.org/article/aa1f037c5eaa42588eeadf71b351fea7 |
| work_keys_str_mv |
AT shelleynfacente performanceofriskbasedcriteriafortargetingacutehivscreeninginsanfrancisco AT christopherdpilcher performanceofriskbasedcriteriafortargetingacutehivscreeninginsanfrancisco AT wendyehartogensis performanceofriskbasedcriteriafortargetingacutehivscreeninginsanfrancisco AT jeffreydklausner performanceofriskbasedcriteriafortargetingacutehivscreeninginsanfrancisco AT susansphilip performanceofriskbasedcriteriafortargetingacutehivscreeninginsanfrancisco AT brianlouie performanceofriskbasedcriteriafortargetingacutehivscreeninginsanfrancisco AT katerinaachristopoulos performanceofriskbasedcriteriafortargetingacutehivscreeninginsanfrancisco AT teridowling performanceofriskbasedcriteriafortargetingacutehivscreeninginsanfrancisco AT grantncolfax performanceofriskbasedcriteriafortargetingacutehivscreeninginsanfrancisco |
| _version_ |
1718424312561532928 |