The document discusses Dallas County Health and Human Services Laboratory's use of HIV-1 RNA testing to detect acute HIV infections. It introduces their testing algorithm, pooling methods used to reduce costs, experience identifying 26 acute HIV cases using RNA testing, and interesting case studies identified. The RNA assay used can detect HIV infection earlier than standard antibody tests alone.

1. Dallas County Health and Human Services Laboratory Testing For Acute HIV Infection Brian Emerson HIV-1 RNA Testing Supervisor Dallas County Health and Human Services Laboratory Ph: (214)-819-1950 Email: brian.emerson@dallascounty.org

8. Introduction to HIV RNA Testing Gen-Probe Aptima HIV-1 & HCV Assay Training Manual Gen-Probe Aptima HIV-1 & HCV Assay Training Manual Negative Specimen Positive Specimen

9. Dallas County HIV Algorithm Bio-Rad Multispot HIV-1/HIV-2 Rapid Test Blood sample received for HIV test ELISA or EIA is performed EIA + (Test repeated X2) EIA Negative Western Blot Western Blot Positive Western Blot Indeterminate Western Blot Negative HIV Positive NAAT Testing NAAT Testing NAAT Positive NAAT Negative AHI Protocol NAAT Positive NAAT Negative Pooled NAAT Testing NAAT Positive AHI Protocol Repeat HIV testing in 1 month Repeat HIV testing in 1 month AHI Protocol NAAT Negative HIV – (Retest based on risk factors)

10. Dallas County HIV Algorithm Blood sample received for HIV test ELISA or EIA is performed EIA Negative Pooled NAAT Testing NAAT Positive AHI Protocol NAAT Negative HIV Negative (Retest based on risk factors)

11. Dallas County HIV Algorithm Bio-Rad Multispot HIV-1/HIV-2 Rapid Test Blood sample received for HIV test ELISA or EIA is performed EIA + (Test repeated X2) Western Blot Western Blot Positive Western Blot Indeterminate HIV Positive NAAT Testing NAAT Positive NAAT Negative AHI Protocol Repeat HIV testing in 1 month

12. Dallas County HIV Algorithm Bio-Rad Multispot HIV-1/HIV-2 Rapid Test Blood sample received for HIV test ELISA or EIA is performed EIA + (Test repeated X2) Western Blot Western Blot Negative NAAT Testing NAAT Positive NAAT Negative AHI Protocol Repeat HIV testing in 1 month

20. Dallas County Laboratory Experience

21. Dallas County Laboratory Experience

22. Dallas County Laboratory Experience Reginald Karen

23. Dallas County Laboratory Experience Daniel Serinaldi Shayma Haq

27. Dallas County Laboratory Experience * Thru April 1, 2010 ŧ Western Blot Indeterminate specimens not included 6.9 12 174 21108 2010* 1.5 9 581 57060 2009 % Increase Confirmed by HIV-1 RNA ŧ Confirmed by Western Blot Total Specimen Tested for HIV Year

29. Dallas County Laboratory Experience BioRad Western Blot Package insert Western Blot Bands Major Bands: p24, gp160, gp120, gp41 Western Blot: Reactive (2 major bands Present) Western Blot: Indeterminate (Only one major band, and/or any minor bands )

32. Dallas County Laboratory Experience Some Interesting Cases: Blood drawn on 01/05/10 and again on 01/15/10 HIV-1 RNA: R HIV-1 RNA: R gp160, p24 Bands Present No Bands Present Western Blot: R Western Blot: NR BioRad EIA: R BioRad EIA: NR 01/15/10 01/05/10