The STOP Study

描述(由申请人提供)：急性艾滋病毒感染(AHI)是指从艾滋病毒传播到抗体产生，在此期间不受阻碍的病毒复制导致血液和生殖器分泌物中的病毒载量极高的时期。因此，在与AHI无保护措施的性行为中传播的可能性非常高；据估计，美国所有新的艾滋病毒感染中有43%是由AHI患者传播的。这具有严重的公共卫生影响，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，特别是在他们不知道自己被感染的情况下。因此，确定患有AHI的个体提供了一个关键机会，以避免大量的后续传播事件。尽管互联网显然是MSM的高危环境，MSM是美国50%以上的新HIV感染病例和北卡罗来纳州56%的AHI病例的罪魁祸首，但互联网作为传统的伴侣通知的补充还没有得到充分的探索。目前使用血清阴性的HIV RNA池检测AHI的NC策略是有效的，但由于第三代血清EIA测试和HIV RNA池策略的技术方面的原因，该策略的缺点包括成本高以及从检测到确认AHI的时间较长。为了克服这些后勤和成本挑战以及从筛查到AHI诊断的延误，这项横断面研究将实施一种新的第四代EIA方法，它同时检测HIV-1/2抗体和p24抗原，从而缩短血清转换窗口期并检测血清转换前p24抗原的存在。这项研究将比较第四代EIA与其他诊断AHI的HIV诊断方法的性能、成本效益和快速程度。研究数据将被用来评估使用新的检测策略可能节省的成本和更早发现AHI的能力，这对在公共资助的艾滋病毒检测地点使用较新的艾滋病毒抗体分析和二级预防具有关键意义。包括我们自己在内的几项研究表明，熟悉和接触互联网为MSM提供了结会性伴侣和从事高危行为的机会。合作伙伴信息的缺乏已被证明限制了通过传统方式完全执行合作伙伴通知的能力。这项研究将把增强的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。使用互联网技术通知合作伙伴还将包括实时链接到艾滋病毒AHI检测地点的信息、与AHI相关的症状以及转诊到艾滋病毒和性传播疾病护理。 公共卫生相关性：几项研究表明，通过性途径传播艾滋病毒的很大一部分是由急性艾滋病毒感染(AHI)驱动的，这可能是由于AHI期间的高病毒负担。因此，确定患有AHI的个人是避免大量后续传播事件和确定艾滋病毒高危个人和性关系网络的关键机会。这具有重大的公共卫生影响，因为AHI患者似乎继续从事导致最近感染艾滋病毒的高风险行为，特别是在他们不知道自己被感染的情况下。

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.