Miami Herald - Sunday, July 27, 2003
Connie Prater, cprater@herald.com

The test is part of a nationwide effort announced today by the U.S. Centers for Disease Control and Prevention, which is trying to get ahead in tracking new cases of the human immunodeficiency virus. HIV infects an estimated 40,000 people each year in the United States.

"We need to know where the infections are happening now," said Marlene LaLota, program administrator in the bureau of HIV/AIDS for the Florida Department of Health.

The current system, she noted, relies primarily on data about AIDS cases, which can be outdated. But those infected with HIV -- as many as 950,000 people in the United States -- can have the virus for nearly a decade, longer if they take antiretroviral drugs, without progressing to AIDS.

"The HIV data that's reported doesn't tell you what's new," said Dr. Gordon Dickinson, chief of infectious diseases at the Miami Veterans Affairs Medical Center. "It doesn't tell you who was infected a couple of months ago. It tells you who was infected in 1990."

Under the program, blood samples of those who test positive for HIV will undergo an additional test, which looks for concentrations of HIV antibodies in the blood. Longtime HIV carriers have more antibodies than those infected in the past six months.

"We are able to use that information . . . to then calculate or estimate overall new infections," Dr. Robert Janssen, director of the CDC's division of HIV/AIDS Prevention, said Friday in a teleconference from Atlanta.

The monitoring system, which started in 2001 at five pilot sites, will be outlined at the National HIV Prevention Conference, today through Wednesday in Atlanta. The conference, convened every two years, features the nation's top experts on HIV prevention research and programs.

The CDC has allocated about $13 million to pay for testing at 35 sites around the country, including state health labs in Miami, Fort Lauderdale and West Palm Beach. All three of those cities rank in the top 10 nationwide for AIDs and HIV cases. Florida got $750,000 earlier this year for the startup of its program, LaLota said.

Miami's oft-quoted ranking at No. 2 in the nation for new infections is based on outdated numbers.

For a true picture of what's really going on in South Florida today, healthcare workers rely on traffic at clinics that treat sexually transmitted diseases or requests for counseling and other services.

"We know Miami has a huge problem," LaLota said. "Every data source shows there's a lot of HIV in Miami. But how was it last year compared to two years ago? That's what we're not able to say."

LaLota acknowledged that the new monitoring system will not capture all of the HIV infections. Only state health department labs are participating, and they account for only 20 percent of all HIV testing conducted in the state; the rest is done through private physicians and clinics.

"Ideally, if you want to measure incidence, you want to know about all the HIV infections," she said, adding that the state hopes to expand to private labs by 2004.

Another limitation: Patients must agree to have their blood tested.

Even though it will be confidential, health officials expect some to be skittish about the new test, and they don't know how many will agree.

Still, the monitoring program is critical to the HIV fight, said AIDS researcher Dr. Margaret Fischl, of the University of Miami School of Medicine.

"About 25 percent to a third of the infected population don't know that they are infected," she said. "That's too high. There is still more work to be done."

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Always watch for outdated information. This article first appeared in 2003. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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