LBP4 Investigation of Incident HIV Infections Among US Army Soldiers Deployed to Iraq and Afghanistan, 2001-2007

Wednesday, March 10, 2010
Grand Ballroom D2/E (M4) (Omni Hotel)
Paul Scott, MD, MPH1, Otha Myles, MD2, Shilpa Hakre, DrPH, MPH3, Eric Sanders-Buell, BS3, Francine McCutchan, PhD3, Robert O'Connell, MD2, Sheila Peel, PhD, MSPH2, Connor Eggleston, MS3, Bruno Petruccelli, MD, MPH4, Micaela Robb-McGrath2, Warren Sateren, MPH2, Steven Tobler, MD, MPH5, Eileen Nolan, RN2, Nelson Michael, MD, PhD2 and Steven Cersovsky, MD, MPH6, 1Walter Reed Army Institute of Research, Military HIV Research Program, Division of Retrovirology, Rockville, MD, 2US Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, MD, 3US Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, 4Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, 5Armed Forces Health Surveillance Center, Silver Spring, MD, 6US Army Public Health Command (Provisional), formerly the US Army Center for Health Promotion and Preventive Medicine (USACHPPM), Aberdeen Proving Ground, MD

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 Iraq and Afghanistan

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 Iraq and Afghanistan during 2001-2007. 

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 US immediately prior to deployment, while on mid-tour leave or immediately following deployment.  

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.

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