The STOP Study

描述（由申请人提供）：项目概述急性HIV感染（AHI）是从HIV传播到抗体产生的时期，在此期间，病毒复制不受阻碍，导致血液和生殖器分泌物中的病毒载量极高。 因此，在无保护性交期间与AHI传播的可能性非常高;估计美国所有新的HIV感染中有43%是由AHI患者传播的。 这对公共卫生具有重要意义，因为AHI患者可能会继续从事导致最近感染艾滋病毒的高危行为，特别是如果他们不知道自己被感染。 因此，识别患有AHI的个体提供了避免大量向前传播事件的关键机会。 虽然互联网已被明确证明是一个高风险的环境，男男性接触者，一组占超过50%的新的艾滋病毒感染在美国和56%的AHI病例在北卡罗来纳州（NC），其使用作为一种补充，传统的合作伙伴通知尚未得到充分探讨。 目前的NC策略，以检测AHI血清阴性者使用合并的HIV RNA检测是有效的，但这种策略的缺点包括高成本和延长时间从测试到确诊AHI诊断由于第三代血清EIA检测和HIV RNA池策略的技术方面。 为了克服这种后勤和成本挑战以及从筛查到AHI诊断的延迟，本横断面研究将实施一种新的第4代EIA检测，其同时检测HIV-1/2抗体和p24抗原，从而减少血清转换窗口期并检测血清转换前p24抗原的存在。 该研究将比较第四代EIA与其他HIV诊断检测的性能、成本效益和快速性，以诊断AHI。研究数据将用于评估潜在的成本节约和使用新的检测策略更早地检测AHI的能力，这对在公共资助的HIV检测站点和二级预防中使用新的HIV抗体检测具有重要意义。 包括我们自己在内的几项研究表明，熟悉和访问互联网为MSM提供了与性伴侣见面和从事高风险行为的机会。 合作伙伴信息的缺乏已被证明限制了通过传统手段完全执行合作伙伴通知的能力。 这项研究将把加强伴侣追踪与一种新的互联网干预措施结合起来，并确定其在增加对急性感染患者伴侣的通知、筛查和治疗方面的可行性、成本效益和收益。 利用互联网技术通知伴侣还将包括实时链接艾滋病毒检测地点的信息，以了解AHI、与AHI相关的症状以及艾滋病毒和性传播疾病护理的转介。 公共卫生相关性：一些研究表明，很大一部分通过性途径传播的艾滋病毒是由急性艾滋病毒感染（AHI）驱动的，这可能是由于AHI期间的高病毒负荷。 因此，识别AHI患者是一个关键的机会，可以避免大量的进一步传播事件，并识别艾滋病毒高风险的个人和性网络。 这具有重大的公共卫生意义，因为AHI患者似乎继续从事导致最近获得HIV的高危行为，特别是如果他们不知道自己被感染。

DESCRIPTION (provided by applicant): Project Summary Acute HIV infection (AHI) is the period from HIV transmission until antibodies develop and during which unimpeded viral replication results in extremely high viral loads in the blood and genital secretions. Accordingly, the probability of transmission during unprotected intercourse with AHI is very high; an estimated 43% of all new HIV infections in the US are transmitted by persons with AHI. This has critical public health implications since individuals with AHI are likely to continue engaging in high-risk behaviors that led to recent HIV acquisition, particularly if they do not know they are infected. As such, identifying individuals with AHI provides a critical opportunity to avert a significant number of onward transmission events. While the Internet has clearly been shown to be a high risk environment for MSM, a group that accounts for over 50% of new HIV infections in the US and 56% of AHI cases in North Carolina (NC), its use as a complement to traditional partner notification has not been fully explored. The current NC strategy to detect AHI using pooled HIV RNA testing on seronegatives is effective, but the disadvantages of this strategy include high cost and a prolonged time from testing to confirmed AHI diagnosis due to technical aspects of 3rd generation serum EIA testing and the HIV RNA pooling strategy. To overcome such logistical and cost challenges and the delay from screening to AHI diagnosis, this cross-sectional study will implement a novel a 4th generation EIA assay, which simultaneously detects HIV-1/2 antibodies and p24 antigen, thereby decreasing the seroconversion window period and detecting the pre-seroconversion presence of p24 antigen. The study will compare the performance, cost-effectiveness, and rapidity of a 4th generation EIA to other HIV diagnostic assays to diagnose AHI. Study data will be used to evaluate the potential cost savings and ability to detect AHI earlier with the use of new testing strategies, with critical implications for the use of newer HIV antibody assays in publicly funded HIV testing sites and secondary prevention. Several studies, including our own, indicate that familiarity with and access to the Internet provides opportunities for MSM to meet sex partners and engage in high risk behaviors. The lack of partner information has been shown to limit the ability to completely perform partner notification by traditional means. This study will incorporate enhanced partner tracing with a novel Internet intervention and determine its feasibility, cost-effectiveness and yield in increasing the notification, screening and treatment of partners of acutely infected patients. The use of internet technologies for partner notification will also include real-time linkage to information on HIV testing sites for AHI, symptoms associated with AHI and referral to HIV and STD care. PUBLIC HEALTH RELEVANCE: Several studies indicate that a significant proportion of HIV transmission by the sexual route is driven by acute HIV infection (AHI), likely due to the high viral burden during AHI. Accordingly, identifying individuals with AHI represents a critical opportunity to avert a significant number of onward transmission events and identify individuals and sexual networks at high risk for HIV. This has momentous public health implications since individuals with AHI appear to continue to engage in the high-risk behaviors that led to recent HIV acquisition, particularly if they do not know they are infected.