Background:
Patients seen at STD clinics may be at particularly high risk for HIV acquisition, and routine HIV testing has been recommended in settings where the prevalence of HIV is > 1%. Since November 2002, all publicly funded HIV testing sites in North Carolina have retested all HIV antibody EIA (-) specimens for HIV RNA after specimen pooling. We examined the impact of acute HIV (AHI) screening in NC STD clinics.

Objective:
We examined the impact of AHI screening in NC STD clinics and AHI clinical presentaion.

Method:
For all cases of AHI identified for the first two years of the NC Screening and Active Tracing Program (STAT), information was collected regarding signs and symptoms of both AHI and other STDs and STD diagnoses.

Result:
From 11/01/2002 through 10/31/04, 91,422 HIV tests were performed in NC STD clinics (41% of all publicly funded tests). 419 were newly Ab+, and 20 additional clients were RNA+/Ab-: HIV antibody tests detected only 95.4% of all detectable infections. The 20 STD clinic acute cases represented 45% of AHI detected across all clinic types. Of these, 13 (65%) were male and 7 (35%) were female. Ten (50%) of the 20 were diagnosed with either another STD or an STD syndrome at the time of acute HIV diagnosis (4 GC, 4TV, 2 BV, 3 with syphilis, HSV or GUD). Only 12 (60%) had any recent symptoms to suggest acute retroviral syndrome (ARS) at testing. When combined, any STD diagnosis and/or recent symptoms of ARS at the time of the visit, 17 of the 20 (85%) cases AHI are identified.

Conclusion:
STD clinics are an important source of acute HIV.

Implications:
Further research is needed to model strategies to target screening for AHI based on STD diagnosis and/or recent ARS