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

2. Background of ACUTE HIV b STAT: Screening and Testing for Active Transmission b The program has been operating since 2002 b 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 b Tests are analyze at state-funded public health virology & serology laboratory; b Serum specimen are tested using a method called pooling & nucleic-acid testing using ultrasensitive HIV RNA RT-PCR test; b Results obtained are confirmed using WB; b In 2002, 4.9 cases per 10,000 clients were identified as a case

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

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

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

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

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

12. DIS Duties/Responsibilities b Locate, Notify, Counsel, Interview, and draw repeat specimen b Transport to first medical visit b Contact tracing for partners & suspects within 72 hours b Schedule follow up visits within a week after interview with all clients b 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: b Many thanks to the following in 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, Communicable Disease BranchDr. Peter Leone: NC Medical Director, Communicable Disease Branch Joann Kuruc: Acute HIV Program Mgr.Joann Kuruc: Acute HIV Program Mgr.