By Kenneth M. Landgraf, HIV Program Specialist, APHL
This month marks 30 years since CDC reported the first cases of the clinical syndrome now known as AIDS.[i] It would be another four years before the arrival of the first HIV test, and fifteen years until the introduction of effective antiretroviral therapy. The ensuing years have seen a massive response on a global scale, with billions of dollars invested in research, outreach, testing, care and treatment initiatives. Still, today CDC estimates that 21% of persons living with HIV in the United States are unaware of their status.[ii] On June 27th, the annual observance of National HIV Testing Day, let us look back at the progress made and remember how much more work needs to be done to confront this terrible pandemic.
From early on in the HIV/AIDS epidemic, public health laboratories played an important role in patient testing. Understanding the importance of an accurate diagnosis, APHL (then known as ASTPHLD) worked with CDC in 1989 to develop the first laboratory diagnostic criteria for HIV.[iii] Laboratory data has been crucial in the efforts to map epidemiologic trends, identify risk groups, diagnose new infections quickly to facilitate entry into care, and provide important surveillance data. With the introduction of CLIA-waived rapid testing in 2003, the role of public health laboratories has begun shifting towards supplemental (i.e. confirmatory) testing services. In 2008, the nation’s public health laboratories conducted over 1.6 million HIV tests and identified over twenty-eight thousand infections.[iv] Many PHLs have also found a role in providing quality assurance training to the rapid testing sites in their jurisdictions to ensure high quality test results regardless of a client’s testing venue.
APHL continues to collaborate with CDC to evaluate new testing technologies as they emerge. Several evaluations are currently underway to look at new strategies for diagnosing HIV. These included updated HIV diagnostic algorithms and implementation of “4th generation” antigen-antibody immunoassays, capable of identifying HIV infections earlier than traditional screening tests.
This June 27th, APHL recognizes the work of our public health laboratory members and all those involved in the fight against HIV/AIDS. For additional information on National HIV Testing Day, please visit the website http://www.aids.gov/awareness-days/national-hiv-testing-day/. To find a testing site near you, visit CDC’s dedicated site, www.hivtest.org.