New H.I.V. Test Identifies Cases in College Students
February 11, 2004
By LAWRENCE K. ALTMAN
SAN FRANCISCO, Feb. 10 - A new H.I.V. test has led health
workers in North Carolina to identify what they and federal
officials say is the first outbreak of the infection ever
among college students.
The outbreak, reported here on Tuesday at the 11th annual
Conference on Retroviruses and Opportunistic Infections,
involved 84 H.I.V. cases in male students ages 18 to 30
from Jan. 1, 2000, through Dec. 31, 2003. The students,
most of whom were black, were enrolled in 37 colleges, all
but 4 in North Carolina.
"We believe that this is a wake-up call" to direct new
efforts to prevent further transmission of the virus among
young people, said Dr. Lisa B. Hightow of the University of
North Carolina. Dr. Hightow is an infectious disease
specialist who worked with the North Carolina health
Her team investigated the outbreak using the new test,
which is based on a technique known as P.C.R. (for
polymerase chain reaction) and which can detect H.I.V., the
AIDS virus, weeks earlier than the standard test. The
initial weeks of H.I.V. infection is a period when the
virus is easily transmitted because it is present in large
amounts in the blood and semen.
Most of the 84 students had tested negative with the
standard H.I.V. antibody test.
North Carolina's program has used the P.C.R. test since
November 2002 with the aim of detecting cases in the first
weeks of infection. The health department has long
interviewed each new infected person to help trace partners
and prevent further transmission of H.I.V.
In December 2002 and January 2003, two male students at the
same college in the same town went for H.I.V. testing.
Their initial antibody tests were negative, but both
students were found to be positive using the new test.
Further testing and investigation led to the detection of 6
cases in male college students ages 18 to 30 in 2000; 19 in
2001; 29 in 2002; and 30 in 2003. Of the 84 students, 73,
or 88 percent, were black and 11 were white.
In the same period, 651 cases were detected in men of the
same age who were not enrolled in college.
The investigation involved only men, so officials do not
know how many women the men infected. But, Dr. Hightow
said, "there is no reason to think that women are not at
In the year preceding their diagnosis, 4 percent of the
students said they had had sex only with women; 58 percent
had sex only with men; and 33 percent had had sex with both
men and women. There was no information about the other 5
About half the men said they acquired their infection from
another person who knew he or she had long been infected
but who did not disclose the infection.
The epidemiologists did not identify any person who
transmitted the virus to numerous partners.
Dr. Peter Leone, medical director of North Carolina's
sexually transmitted disease program, said the program cost
about $300,000 for the 120,000 tests it did each year. That
represents about $2 a test more than the standard antibody
Dr. Harold W. Jaffe, the head of the AIDS program at the
federal Centers for Disease Control and Prevention, which
assisted in the investigation, said that in the 1990's a
different kind of survey found low rates of H.I.V.
infection on 10 college campuses but not the kind of
network uncovered in North Carolina.
In another report at the conference, the largest study of
surgical outcomes among patients treated for H.I.V.
infection found that they fared as well as noninfected
The study involved infected members of the
Kaiser-Permanente health system in northern California who
underwent a number of surgical procedures from July 1997 to
June 2002. They included operations on the heart; to remove
an inflamed appendix, gallbladder or uterus; to remove
cancers from the breast and colon; andrepair hernias and
A Kaiser-Permanente team led by Dr. Michael Horberg
analyzed the charts of 641 infected patients and 256 of 395
noninfected patients. A year after surgery, there were
seven deaths among the infected patients and two among the
noninfected. But the team attributed the deaths in infected
patients to pre-existing conditions other than H.I.V.
Infected patients with a viral count greater than 10,000 at
the time of surgery had a higher rate of complications, 23
percent, compared with 8 percent among those with a count
less than 10,000.
The team undertook the study because doctors had a
perception that suppressed immune function from H.I.V.
would lead to a worse surgical outcome among infected
patients. The team concluded that "H.I.V. status should not
by itself be a criterion for surgical consideration."