Acute HIV Follow-Up in NCAcute HIV Follow-Up in NC

Presented by Presented by

Muhammad “Maxi” Mackalo, Muhammad “Maxi” Mackalo, DISDIS

Background of ACUTE HIVBackground of ACUTE HIV

STAT: Screening and Testing for Active STAT: Screening and Testing for Active TransmissionTransmission

The program has been operating since The program has been operating since 20022002

Dr Leone, Medical Director, Dr Leone, Medical Director, Communicable Disease Branch is one Communicable Disease Branch is one of the co-founders of the study and is of the co-founders of the study and is currently superheading the program currently superheading the program operationoperation

Detection/TestingDetection/Testing

Tests are analyze at state-funded public Tests are analyze at state-funded public health virology & serology laboratory;health virology & serology laboratory;

Serum specimen are tested using a Serum specimen are tested using a method called pooling & nucleic-acid method called pooling & nucleic-acid testing using ultrasensitive HIV RNA RT-testing using ultrasensitive HIV RNA RT-PCR test;PCR test;

Results obtained are confirmed using WB;Results obtained are confirmed using WB; In 2002, 4.9 cases per 10,000 clients In 2002, 4.9 cases per 10,000 clients

were identified as a casewere identified as a case

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

SymptomsSymptoms

Acute Retroviral syndrome (Mostly Acute Retroviral syndrome (Mostly Flu-like symptoms) such as:Flu-like symptoms) such as:• Fever, rash, headache, night Fever, rash, headache, night

sweats, fatigue, malaise, athralgia, sweats, fatigue, malaise, athralgia, myalgia, pharyngitis, swollen myalgia, pharyngitis, swollen lymph nodes, weight Loss (~ 6 lbs. lymph nodes, weight Loss (~ 6 lbs. or more), loss of appetite, oral or more), loss of appetite, oral ulcers, nausea, vomiting and ulcers, nausea, vomiting and diarrheadiarrhea

Risk FactorsRisk Factors

Unprotected receptive & insertive anal Unprotected receptive & insertive anal sex;sex;

The sharing of IV drug paraphernalia ;The sharing of IV drug paraphernalia ; Unprotected vaginal sex;Unprotected vaginal sex; Receptive oral sex with a male partner;Receptive oral sex with a male partner; Exposure to HIV/AIDS via any exchange Exposure to HIV/AIDS via any exchange

of bodily fluids (ex: needle stick) .of bodily fluids (ex: needle stick) .

DiagnosisDiagnosis

All clients with (-) EIA (+) NAAT results, as All clients with (-) EIA (+) NAAT results, as well as EIA (+) WB (-) or Indeterminate well as EIA (+) WB (-) or Indeterminate with a (+) NAAT need to be followed by with a (+) NAAT need to be followed by DIS for notification, counseling, interview DIS for notification, counseling, interview & repeat HIV serology for confirmation of & repeat HIV serology for confirmation of HIV infectionHIV infection

Clients with a (-) HIV antibody test within Clients with a (-) HIV antibody test within the previous month followed by (+) the previous month followed by (+) EIA/WB test are also identified as acute EIA/WB test are also identified as acute HIV casesHIV cases

Diagnosis Cont.

Community Acute:•Detected outside NCSLPH; and•Initial testing is performed by a

PMD or another community clinic;

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 (-)

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

ReferralReferral

Persons identified with acute HIV are offered Persons identified with acute HIV are offered immediate access to care via the Acute HIV immediate access to care via the Acute HIV Program @ UNCProgram @ UNC• Statewide network of providers Statewide network of providers • Medical Evaluation and assessment by a clinician Medical Evaluation and assessment by a clinician

familiar with acute HIV infectionfamiliar with acute HIV infection• Receive information about HIV & acute HIV Receive information about HIV & acute HIV

infectioninfection• Financial, social & psychological assistance Financial, social & psychological assistance

availableavailable• Discuss concern(s) with diagnosis and treatmentDiscuss concern(s) with diagnosis and treatment• Provide information for care options and Provide information for care options and

applicable research opportunitiesapplicable research opportunities

DIS Duties/ResponsibilitiesDIS Duties/Responsibilities

Locate, Notify, Counsel, Interview, and draw Locate, Notify, Counsel, Interview, and draw repeat specimenrepeat specimen

Transport to first medical visitTransport to first medical visit Contact tracing for partners & suspects within Contact tracing for partners & suspects within

72 hours72 hours Schedule follow up visits within a week after Schedule follow up visits within a week after

interview with all clientsinterview with all clients Additional STAT research program -Additional STAT research program -

1. Obtain consent to allow initial blood samples to go 1. Obtain consent to allow initial blood samples to go to UNC for testing to UNC for testing

2. HIPAA release form to discuss sexual -social 2. HIPAA release form to discuss sexual -social networks for state epidemiology and outbreak networks for state epidemiology and outbreak information information

Acknowledgement:Acknowledgement:

Many thanks to the following in Many thanks to the following in preparation of this presentation:preparation of this presentation:• Todd Vanhoy: NC Field Service Mgr.Todd Vanhoy: NC Field Service Mgr.• Rhonda Ashby: Asst. Field Service Mgr.Rhonda Ashby: Asst. Field Service Mgr.• Dr. Peter Leone: NC Medical Director, Dr. Peter Leone: NC Medical Director,

Communicable Disease BranchCommunicable Disease Branch• Joann Kuruc: Acute HIV Program Mgr.Joann Kuruc: Acute HIV Program Mgr.