Finding Acute HIV Infection at New York City Department of Health and Mental Hygiene's Sexually Transmitted Disease Clinics, 2010-2012

Background:  Acute HIV infection (AHI) is characterized by peak infectiousness, undetectable HIV antibody, and detectable virus.   Since 2010, New York State HIV law requires HIV testing be offered to all persons 13 to 64 years receiving hospital or primary care services.    Opt-out HIV antibody testing was implemented at the New York City (NYC) Department of Health and Mental Hygiene’s (DOHMH’s) Sexually Transmitted Disease (STD) clinics in 2008.   Targeted AHI testing of those at risk of recent HIV exposure began in 2010.

Methods:  We measured annual contributions from NYC STD clinic s to NYC HIV surveillance data, from calendar years (CY) 2010-2012, and described AHI cases diagnosed in NYC STD clinics, using medical record data.  The Cochrane-Armitage test was used to evaluate trends.

Results:  During  CYs  2010, 2011 and 2012, NYC DOHMH STD clinics diagnosed  530, 479 and  438 HIV cases , representing  11.3%, 10.8%, and 10.9%  of all  HIV cases reported in NYC, respectively; and   35, 39, and 43 AHI cases, contributing  20.2%, 23.6%,and 19.8%  of all AHI case reports.   AHI cases represented an increasing proportion of STD clinic-based HIV diagnoses (6.6% (35/530), in 2010; 8.1% (39/479), in 2011; 10.9% (48/438), in 2012; p=0.02). Among the 122 AHI cases diagnosed from 2010-2012, all were male, but one.  All male cases were AHI tested based on report of sex with other men over the prior two months.  There were no significant changes in median age, race-ethnicity, or borough of residence of AHI cases from2010-2012.

Conclusions:  From 2010-2012, NYC DOHMH STD clinics consistently accounted for ~ 11% of NYC’s reported HIV cases and ~20% of reported AHI cases. Among new HIV diagnoses made at the STD clinics, an increasing proportion are AHI, affording the earliest possible linkage to care and viral load suppression.