Background:By Army regulation, HIV-infected soldiers are not eligible to deploy. The combat environment presents a health hazard to HIV-infected soldiers and they pose a threat to the battlefield blood supply and to their contacts. Currently, soldiers are screened for HIV infection within 90 days prior to, and within 30 days after, combat deployment. Army investigators observed a possible increase in HIV incidence associated with deployment to
Objectives:To define the peri-deployment time period, the geographic location, and the mode of transmission for incident HIV infections among 1,134,001 Army soldiers deployed to
Methods:Investigators collected and analyzed data from clinical/public health interviews; existing personnel, deployment, and clinical encounter records; laboratory results; nucleic acid amplification testing of sero-negative pre-deployment archived serum; and HIV-1 genotyping of clinical samples from the interview.
Results:Among 48 of 64 eligible subjects with deployment-associated HIV infections, most infections were acquired prior to deployment (n=20, 42%), during mid-tour leave (n=13, 27%), and immediately after deployment (n=5, 10%). All were subtype B infections acquired through sexual contact. Seven sero-negative acute infections were identified in the pre-deployment period. Twenty-three (48%) had clinically apparent acute retroviral syndromes.
Conclusions:Most deployment-associated HIV infections are acquired in the
Implications for Programs, Policy, and/or Research:These findings can inform development of targeted preventive interventions and peri-deployment HIV testing policy. Clinicians should consider acute HIV infection in the differential diagnosis of soldiers and veterans presenting with non-specific illnesses in close proximity to combat deployment. Additional study is warranted to determine if deployment is a risk factor for HIV infection.