Performance of Risk-Based Criteria for Targeting Acute HIV Screening in San Francisco 英文参考文献.docVIP

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Performance of Risk-Based Criteria for Targeting Acute HIV Screening in San Francisco 英文参考文献.doc

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Performance of Risk-Based Criteria for Targeting Acute HIV Screening in San Francisco 英文参考文献

PerformanceofRisk-BasedCriteriaforTargetingAcute HIVScreeninginSanFrancisco ShelleyN.Facente1,2*.,ChristopherD.Pilcher2.,WendyE.Hartogensis2,JeffreyD.Klausner3, SusanS.Philip3,BrianLouie4,KaterinaA.Christopoulos2,TeriDowling5,GrantN.Colfax5 1FacenteConsulting,SanFrancisco,California,UnitedStatesofAmerica,2SanFranciscoGeneralHospitalHIV/AIDSDivision,UniversityofCaliforniaSanFrancisco,San Francisco, California, United States of America, 3San Francisco Department of Public Health, STD Prevention and Control, San Francisco, California, United States of America, 4San Francisco Department of Public Health Microbiology Laboratory, San Francisco, California, United States of America, 5HIV Prevention Section, San FranciscoDepartmentofPublicHealth,SanFrancisco,California,UnitedStatesofAmerica Abstract Background: Federal guidelines now recommend supplemental HIV RNA testing for persons at high risk for acute HIV infection.However,manyrapidHIVtestingsitesdonotincludeHIVRNAorp24antigentestingduetoconcernsaboutcost, theneedforresultsfollow-up,andtheimpactofexpandedvenipunctureonclinicflow.Wedevelopedcriteriatoidentify patientsinamunicipalSTDclinicinSanFranciscowhoareasymptomaticbutmaystillbelikelytohaveacuteinfection. Methods:DatawerefrompatientstestedwithserialHIVantibodyandHIVRNAteststoidentifyacuteHIVinfection.BED- CEIAresultswereusedtoclassifynon-acutecasesasrecentorlongstanding.Demographicsandself-reportedriskbehaviors were collected at time of testing. Multivariate models were developed and preliminarily evaluated using predictors associatedwithrecentinfectioninbivariateanalysesasaproxyforacuteHIVinfection.Multivariatemodelsdemonstrating $70%sensitivityforrecentinfectionwhiletesting#60%ofpatientsinthisdevelopmentdatasetwerethenvalidatedby determiningtheirperformanceinidentifyingacuteinfections. Results: From 2004–2007, 137 of 12,622 testers had recent and 36 had acute infections. A model limiting acute HIV screeningtoMSMplusanyoneofaseriesofotherpredictorsresultedinasens