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Clinical indicators associated with HIV acquisition in the United States Air Force
59th Medical Wing San Antonio United States
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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 n452 between 1996 and 2011 matched to five randomly selected controls n2, 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, 95CI 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 p0.0 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.
APPROVED FOR PUBLIC RELEASE