Dr. Lisa B. Hightow, a fellow in infectious diseases at the UNC School of Medicine, is the lead author of a research abstract presented Wednesday at the 2003 National HIV Prevention Conference in Atlanta. The state's lead investigator was Dr. Peter Leone, associate professor in the departments of medicine, epidemiology and microbiology and immunology in the UNC schools of medicine and public health. Leone also is medical director of the HIV/STD Prevention and Care Branch of the N.C. Department of Health and Human Services.
This project began after the North Carolina Screening and Tracing Active Transmission (STAT) Program added HIV RNA screening to its existing battery of HIV tests in November 2002. HIV RNA screening can detect tiny amounts of infection long before antibodies are present in the blood, and thus enables HIV to be identified much sooner.
Researchers noticed that of five people with acute infections detected in a three-month period, two were male students attending the same college in the same town. So, to determine if this signaled a larger trend, they reviewed state records of newly reported confirmed HIV cases in Durham, Orange and Wake counties from January 2001 through February 2003.
They found that 146 men and 88 women were reported HIV-positive during this period. Seventeen percent of the infected men were college students, but none of the women attended college. Of the men, 88 percent were black men who have sex with other men.
Compared to other groups, a greater proportion of college men in the study was black, visited gay clubs, used ecstasy and other club drugs and met sex partners over the Internet. Fewer of the college men had only female sex partners or had sex with someone known to be infected with HIV or AIDS. In addition, a partner network linked seven North Carolina colleges together.
The project enabled the state to respond "rather quickly to an outbreak of HIV in a very vulnerable population that may serve as a bridge to women as well," Leone said.
"This group did not self identify as at risk at the time of counseling and testing," he said. "In addition, without having the acute HIV project we would have never picked up on this outbreak."
Because the researchers saw early on that there were two college students among the first five people diagnosed with HIV after the addition of HIV RNA screening, they asked lots of questions and performed an extensive review of cases across the state. "We anticipate now that we may have as many as 60 or more college students in North Carolina that have been recently infected with HIV," Leone said.
Dr. Christopher Pilcher, one of the abstract's co-authors and an assistant professor in UNC's infectious diseases division in the School of Medicine, said the new testing procedure enables public health investigators to understand the specific circumstances that lead to particular outbreaks of HIV infection. This information then can be used to guide an investigation into the outbreak.
The fact that college campuses were shown to be high-transmission areas for HIV is something that had not been seen before in more than two decades of HIV research.
"This is a first indication that there may be a resurgence of HIV happening in a vulnerable population, in this case young black men in the South," Pilcher said. "We think this is a clear indication that more attention should be focused on HIV prevention and education."
Hightow's UNC co-authors included Leone, Pilcher, Pia D.M. McDonald, an assistant research professor in the department of epidemiology in the School of Public Health and project director at the N.C. Center for Public Health Preparedness; Dr. Andrew H. Kaplan, an associate professor in the departments of medicine and microbiology and immunology; and Trang Q. Nguyen, project coordinator for the STAT program and a doctoral student in the department of epidemiology. An additional co-author was Evelyn Foust, head of the HIV/STD Prevention and Care Branch in the N.C. Department of Health and Human Services in Raleigh.
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