CDC is moving quickly to monitor HIV incidence across the country using its "detuned" testing technology, with nearly $6 million this year committed to 24 sentinel cities. With the advent of highly active antiretroviral therapy, CDC surveillance has lost its edge in following the HIV epidemic as the time gap between HIV infection and progression to AIDS has grown increasingly wide. While HIV reporting is required in most states, some of the most populous states still report only AIDS cases, giving CDC an incomplete picture of trends in new infections.

To solve that problem, CDC created the Serological Testing Algorithm for Recent HIV Seroconversion (STARHS). The algorithm is based on the simple idea that antibodies to HIV rise through the period of infection. The "detuned" test allows researchers to identify newly infected people -- within four to six months -- with a fairly high degree of sensitivity. Since 2001, CDC has been working to make STARHS its strategy for monitoring HIV incidence across the country.

After numerous consultations, CDC funded five demonstration sites to develop protocols and explore methodologies for integrating the detuned technology into HIV surveillance activities. The technical issues are complex and involve not only testing specimens but collecting data on testing histories. To enable statisticians to estimate HIV incidence in the general population, information is needed on how often people are tested for HIV.

The 24 sites were selected based on having HIV reporting in place prior to January 2001 and having greater than 300 AIDS cases per year. Several consent issues surrounding STARHS must be worked out. One of the more sticky ones is whether results from detuned testing can be given back to patients. That would require setting up institutional review boards and getting consent, said Matthew McKenna, MD, director of CDC's HIV Incidence and Case Surveillance Branch.

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