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Putting the 'Test' in Test and Treat: Thinking About HIV Testing in 2012
Slide Presentation
October 31, 2012
Christopher Pilcher, MD

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Slide 1.
Putting the 'Test' in Test and Treat: Thinking About HIV Testing in 2012
Slide 1.
HIV Testing in a Test and Treat Era
Slide 2.
The National HIV/AIDS Strategy
Slide 3.
The San Francisco Epidemic
Slide 4.
HIV Testing in San Francisco
Slide 5.
More Frequent Testing, More Acute Infections
Slide 6.
Diagnosing Early HIV Infection
Slide 7.
Late HIV Diagnosis in San Francisco: SFDPH Surveillance, 2009-2010
Slide 8.
Seeking the Untested HIV+
Slide 9.
The SFGH Model
Slide 10.
Where is Testing Going in 2012?
Slide 11.
Bold model - Universal HIV testing, Immediate Treatment, Eliminate HIV
Slide 12.
Early ART and Prevention in SF
Slide 13.
Early ART and Prevention in SF
Slide 14.
Acute HIV and Sexual HIV Transmission
Slide 15.
Early ART and Prevention in SF
Slide 16.
Acute HIV and Sexual HIV Transmission
Slide 17.
Acute HIV and Sexual HIV Transmission
Slide 18.
Acute HIV and Sexual HIV Transmission
Slide 19.
Acute HIV and Sexual HIV Transmission
Slide 20.
HIV Spreads in Sexual Networks
Slide 21.
HIV Spreads in Sexual Networks
Slide 22.
HIV Spreads in Sexual Networks
Slide 23.
HIV Spreads in Sexual Networks
Slide 24.
Contribution of Acute HIV Transmission Depends on Epidemic Stage
Slide 25.
Epidemiologic Linkages Using Phylogenetic Analysis: Quebec
Slide 26.
The Post Test-and-Treat World
Slide 27.
Fighting Fires
Slide 28.
Recognition of Outbreaks = Acute Case Identification = Opportunities for Intervention
Slide 29.
Shifts in CDC Testing Policy
Slide 30.
Imminent CDC Policy Shifts
Slide 31.
New Testing Technologies
Slide 32.
Sensitivity of HIV Assays for 54 RNA + Acute Cases (n=21,234, SFDPH Sites 2004-8)
Slide 33.
Multi-Platform Analyzers
Slide 34.
AMPLIAR Study 010: a Prospective Trial of Rapid Results Acute HIV Testing
Slide 36.
Recent HIV Infection Staging Tests?
Slide 36.
Western Blot and Individual Staging
Slide 37.
New Supplemental Tests to Replace IFA and WB in 2012 CDC Algorithms
Slide 38.
Slide 39
Slide 39.
Slide 40
Slide 40.
DPP(TM) HIV 1/2
Slide 41.
Chembio DPP(TM) Reader
Slide 42.
Biorad Geenius(TM) System
Slide 43.
DPP vs. Western blot
Slide 44.
AMPLIAR Study 020: Evolution of gp160 Reflectance over Time (n=23)
Slide 45.
Advantages of RTs for Clinical Staging
Slide 46.
Pitfalls of RTs for Clinical Staging and Surveillance Uses
Slide 47.
DPP Preliminary Performance for Individual Staging
Slide 48.
Scatterplot of gp160 Band Reflectance on DPP Assay vs. Duration of HIV Infection
Slide 49.
Scatterplot of gp120 Band Reflectance on DPP Assay vs. Duration of HIV Infection
Slide 50.
Sequential Band Evolution on DPP HIV Assay
Slide 51.
Evolution of gp160 Band Reflectance in Subtype B vs. C HIV infection, Southern Brazil
Slide 51.
Evolution of gp160 Band Reflectance in Subtype B vs. C HIV infection, Southern Brazil
Slide 51.
Evolution of gp160 Band Reflectance in Subtype B vs. C HIV infection, Soouthern Brazil
Slide 54.
DPP HIV 1/2 Confirmatory Immunoblot (n=237 specimens)
Slide 55.
DPP Rapid Tests
Slide 56.
Conclusions
Slide 57.
Conclusions (2)
Slide 58.
Acknowledgements
Slide 59.
Ricardo da Silva de Souza MD, MHA, PhD
Slide 60.

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