Background:  The detection of acute HIV infection is a valuable public health opportunity to interrupt transmission during a time of heightened infectiousness. We evaluated the effectiveness of partner counseling and referral services for acute HIV infection clients in North Carolina.

Methods:  Since 2002, the North Carolina State Laboratory of Public Health has retested HIV antibody enzyme-linked immunoassay (EIA) specimens from publicly funded testing sites for HIV RNA using specimen pooling. Clients with unconfirmed acute HIV infection are notified and offered confirmatory testing within 72 hours by Disease Intervention Specialists. Sex and needle-sharing partners in the previous 8 weeks are contacted and offered HIV testing within 72 hours of the acute HIV infection client interview.

Results:  From November 1, 2002 to September 1, 2007, we identified 89 acute HIV infection clients, representing an increased diagnostic yield of 3.3% over antibody testing alone. We located 82 clients (92%) who used partner counseling and referral services services. Acute HIV infection clients reported a mean of 3 (range 0 to 27) partners in the past 8 weeks, 1.2 anonymous and 1.8 named. Of 251 partners reported, 148 (59%) were named and 118 (80% named partners, 47% all partners) were located and counseled. Of those counseled, 46 (39%) were known to be positive. Testing of the remaining 67 partners revealed 11 (16%) newly identified positives:  3 acute and 8 newly diagnosed, antibody-positive infections. Phylogenetic analysis of 3 partnerships established a genetic linkage between the known positive partner and acute HIV infection case. Of 46 previously identified positives, 33 (72%) had a current care provider and 33 (43%) reported prior or current HAART use. Genotypic analysis of 69 acute HIV infection specimens revealed mutations conferring single-class resistance in 11 (16%) cases and two-class resistance in 1 (1%) case. Of the 5 (7%) with NNRTI resistance, 4 were high-level (3 K103N, 1 Y188L). Oof 12 clients with resistance, 7 (58%) had partners with known established infections.

Conclusions:  The program’s success at rapidly counseling 92% of acute HIV infection cases and 80% of named partners provides strong evidence for the potential effectiveness of partner counseling and referral services in the acute HIV infection setting. The link between transmitted resistance and known positive partners suggests that HIV transmission in the southeastern United States may be driven by chronically infected persons in care, contrasting with reports from urban settings. These data emphasize the importance of surveillance for transmitted resistance and prevention programs for people living with HIV/AIDS.