New Frontiers in HIV Testing

It is understandable why advances in the development of anti-HIV drugs have so dominated media stories about the AIDS epidemic in recent years. The advent of highly active antiretroviral therapy has had such a tremendous impact on HIV morbidity and mortality that early commentators of the phenomenon often referred to "the Lazarus effect" when describing the profound improvements in health and vitality resulting from these new therapies.

Less visible and not as well recognized by the general public--but equally impressive in their own right-- are the progressive improvements that have taken place in laboratory science since the first test to diagnose HIV was licensed in 1985.

A symposium this week at the 19th Conference on Retroviruses and Opportunistic Infections (CROIExit Disclaimer was devoted to this very topic. Dr. Bernie Branson from CDC explained that 3rd and 4th generation HIV laboratory tests have become progressively more sensitive, narrowing further and further the "window period"-- that is, the interval of time between infection with HIV and the ability of a laboratory test to diagnose infection. In fact, CDC is working on a new HIV testing algorithm that recognizes this improved sensitivity and will recommend a more streamlined approach to HIV diagnostic testing.

Of course, advances in HIV testing technology are only beneficial to the degree that they are put into practice. Namely, ensuring that HIV testing is widely available and that test results empower/enable the person being tested to make positive health choices. This includes prompt referral to care for those who are found to be infected with HIV and ongoing prevention support for high-risk seronegative persons.

Dr. Blayne Cutler from the New York City Department of Health shared New York City's successful experience with expanding access to HIV testing. Employing a multi-pronged strategy that included incentives (for example, performance contracts), social marketing campaigns, targeted technical assistance, and legislative change, their efforts have resulted in over 700,000 HIV tests being performed and 2,000 new HIV diagnoses.

Other panel presentations included Ms. Nduku Kilonzo who spoke about her experiences scaling-up HIV counseling and testing services in Kenya and Dr. Patrick Sullivan who described various aspects of HIV results disclosure, including couples testing programs for gay men.

Other presentations at CROI dealt with the important issue of promoting early HIV diagnosis and facilitating linkage into life-saving care. Please take the time to visit the CROI website and read these abstracts Exit Disclaimer. Several of the presentations are also available as webcasts, audio files, and slide sets, which you can find on the CROI websiteExit Disclaimer. You may find some useful ideas and approaches to help with your own local efforts to address the National HIV/AIDS Strategy's goal of increasing the percentage of undiagnosed infected persons who are tested and promptly referred into care.