Raleigh News & Observer Examines North Carolina’s HIV Nucleic Acid Testing Program

The Raleigh News & Observer on Tuesday examined North Carolina's nucleic acid testing program -- which can detect HIV two to three weeks earlier than standard screening -- and its influence on HIV testing programs both nationally and internationally. Since North Carolina presented results of its NAT program at a conference in 2004, "nearly a dozen major public health centers nationally have established similar programs or plan to do so," and health care providers worldwide are examining it, the News & Observer reports (Fisher, Raleigh News & Observer, 3/21). Nucleic acid testing, which was developed in 1999, is used to test units of donated blood for HIV. NAT can detect minute amounts of viral genetic material in pooled plasma samples by amplifying gene fragments of the virus. If a pool tests positive for HIV, the individual sample can be detected and removed for further processing, and the donor can be deferred and notified. Because NAT looks for the virus and not antibodies, health professionals are able to identify HIV-positive patients in the days immediately following infection -- when they are most contagious (Kaiser Daily HIV/AIDS Report, 5/6/05). North Carolina's program includes both standard screening and NAT, and those who test positive usually are notified within 72 hours and counseled to begin antiretroviral drug treatment, according to Evelyn Foust, head of the state's HIV-prevention branch. The state then interviews HIV-positive people and attempts to contact people to whom they might have transmitted the virus (Raleigh News & Observer, 3/21).

Results, Costs
Researchers at the University of North Carolina-Chapel Hill -- in collaboration with the North Carolina Division of Public Health -- in the May 5, 2005, issue of the New England Journal of Medicine published results from 109,250 patients tested between November 2002 and October 2003 at state-funded testing sites. They found 583 HIV-positive people using standard HIV antibody testing but identified an additional 23 cases when they used NAT (Kaiser Daily HIV/AIDS Report, 5/6/05). According to the News & Observer, North Carolina's program has found that about 4% of people have falsely tested HIV-negative with standard screening. North Carolina between November 2002 and April 2005 also diagnosed five pregnant women as acutely HIV-positive -- meaning that they were in the early stages in HIV-infection -- and prevented mother-to-child transmission of the virus in all five cases. North Carolina spends about $300,000 in state funds and tests about 120,000 people annually for the virus using NAT, according to Peter Leone, medical director of the state's HIV prevention branch. He added that because public health experts estimate that preventing one HIV case saves about $300,000 in lifetime treatment costs, preventing one or two cases annually pays for the program (Raleigh News & Observer, 3/21).