Clinical indicators associated with HIV acquisition in the United States Air Force
Abstract
Mandatory HIV screening of United States Air Force (USAF) personnel every 2 years effectively identifies incident cases, however testing frequency limits the ability to detect early HIV infection. Identifying clinical indicators of HIV in the USAF population is necessary to develop a supplemental provider-based targeted testing strategy. We conducted a matched case control study of male active duty USAF personnel with a new HIV diagnosis (n=452) between 1996 and 2011 matched to five randomly selected controls (n=2, 176). The relationship between clinical diagnoses, determined by ICD-9 codes, and HIV infection was assessed using conditional logistic regression. In unadjusted analyses of ICD-9 codes ever and within the last 2 years before HlV diagnosis, the conditional odds of HIV infection were greater in those with clinical signs and symptoms of HIV (cOR 5.05, 95% CI 4.00-6.39), mental health diagnoses (cOR 2.61, 95% CI 1.86-3.67), and STI diagnoses (cOR 2.33, 95% CI 1.50-3.60). Compared to those with less or equal to 10 medical encounters in the 2 years prior to HIV diagnosis, individuals with 11-35medical encounters (cOR 2. 19, 95% Cl 1.73-2.79) and >35 medical encounters (cOR 4.15, 95%CI 2.69-6.39) had a higher odds of HIV acquisition. In multivariate analyses, clinical signs and symptoms of HIV within the last 2 years of HIV diagnosis (cOR 4.10, 95% CI 3.22-5.22) andever having a mental health diagnosis (cOR 1.97, 95% CI 1.44-2.70) remained significant (p<0.0 1). Clinical encounters, particularly those featuring clinical signs and symptoms of HIVor a history of mental health complaints, provide an opportunity for targeted testing as a supplement to mandated testing at 2-year intervals. Provider education to increase HIV testing in persons at risk would enhance early HIV diagnosis and potentially reduce forward transmission in the USAF population.
Document Details
- Document Type
- Technical Report
- Publication Date
- Dec 09, 2016
- Accession Number
- AD1036237
Entities
People
- William Hannah
Organizations
- 59th Medical Wing