Evaluation of the diagnostic performance of the rapid test VIKIA HIV1/2 in a highly complex HIV-1 epidemic

Performance of commercially available HIV in vitro diagnostic assays: A systematic review and meta-analysis

Efficient and fast detection of HIV infection is required to make the diagnosis more robust. Use of in vitro HIV diagnostic assays based on different methods are growing rapidly. To maintain quality and further upgradation, regular performance evaluation is required. Due to presence of huge number and types of commercially available kits, choice of implementation varies differentially. The present systematic review and meta-analysis is aimed to address the diagnostic performance of commercially available in vitro HIV assays in terms of pooled sensitivity, specificity, Positive Likelihood Ratio, Negative Likelihood Ratio, area under hierarchical summary receiver operating characteristic curve and diagnostic odds ratios, in global scenario. Total of 18 articles with 35 in vitro diagnostic serological assays including 29,713 samples were subjected for the present pooled analysis. In spite of higher heterogenicity [I² = 93.5%, Q = 520.95, df = 34 (p = 0.0000), τ² = 9.7464], the pooled sensitivity and specificity of the diagnostic serological assays were observed ≥ 98%.

Evaluation of Blood-Based Antibody Rapid Testing for HIV Early Therapy: A Meta-Analysis of the Evidence

Background

Western blot (WB) assay is considered the gold standard test for HIV infection confirmation. However, it requires technical expertise and is quite time-consuming. WHO recommends blood-based rapid diagnosis to achieve same-day test and treatment. However, this rapid testing strategy has not been promoted worldwide due to inadequate research evaluating the effectiveness of rapid tests (RTs) as an alternative confirmatory HIV test for WB. This study aims to compare the diagnostic performance of rapid HIV tests compared with WB.

Methods

PubMed and Web of Science were searched for publications on rapid HIV tests using blood specimen. A meta-analysis was performed to quantitatively evaluate the diagnostic performance of rapid HIV tests compared with the WB assay in terms of pooled sensitivity, specificity, area under summary receiver operating characteristic (SROC) curve, and diagnostic odds ratio (DOR).

Results

Twenty articles involving 27,343 fresh specimens for rapid HIV tests were included in the meta-analysis. Regarding Capillus HIV-1/HIV-2, the pooled sensitivity, specificity, area under SROC curve, and DOR derived from six studies were 0.999 (95% CI, 0.956-1.000), 0.999 (95% CI, 0.991-1.00), 1.00 (95% CI, 0.99-1.00), and 1.0 × 10⁶ (95% CI, 2.6 × 10⁴-3.9 × 10⁷) compared with the WB assay, respectively. With respect to Determine HIV-1/2, the pooled sensitivity, specificity area under SROC, and DOR derived from eight studies were 1.00 (95% CI, 0.789-1.000), 0.992 (95% CI, 0.985-0.996), 1.00 (95% CI, 0.99-1.00), and 1.8 × 10⁶ (95% CI 406.049-7.8 × 10⁹) compared with the WB assay, respectively. Regarding two-step serial RTs, the pooled sensitivity, specificity area under SROC, and DOR derived from eight studies were 0.998 (95% CI, 0.991-1.000), 0.998 (95% CI, 0.994-0.999), and 1.00 (95% CI 0.99-1.00) compared with the WB assay, respectively.

Conclusion

Our meta-analysis results may provide evidenced-based support for substituting RT for WB. Blood-based rapid HIV tests have comparable sensitivity and specificity to WB for HIV early therapy.

Evaluation of five simple rapid HIV assays for potential use in the Brazilian national HIV testing algorithm

Since 2005, the Department of Sexually Transmitted Diseases (STDs), Acquired Immunodeficiency Syndrome (AIDS) and Viral Hepatitis under the Health Surveillance Secretariat in Brazil's Ministry of Health has approved a testing algorithm for using rapid human immunodeficiency virus (HIV) tests in the country. Given the constant emergence of new rapid HIV tests in the market, it is necessary to maintain an evaluation program for them. Conscious of this need, this multicenter study was conducted to evaluate five commercially available rapid HIV tests used to detect anti-HIV antibodies in Brazil. The five commercial rapid tests under assessment were the VIKIA HIV-1/2 (bioMérieux, Rio de Janeiro, Brazil), the Rapid Check HIV 1 & 2 (Center of Infectious Diseases, Federal University of Espírito Santo, Vitória, Brazil), the HIV-1/2 3.0 Strip Test Bioeasy (S.D., Kyonggi-do, South Korea), the Labtest HIV (Labtest Diagnóstica, Lagoa Santa, Brazil) and the HIV-1/2 Rapid Test Bio-Manguinhos (Oswaldo Cruz Foundation, Rio de Janeiro, Brazil). A total of 972 whole-blood samples were collected from HIV-infected patients, pregnant women and individuals seeking voluntary counselling and testing who were recruited from five centers in different regions of the country. Informed consent was obtained from the study participants. The results were compared with those obtained using the HIV algorithm used currently in Brazil, which includes two enzyme immunoassays and one Western blot test. The operational performance of each assay was also compared to the defined criteria. A total of 972 samples were tested using reference assays, and the results indicated 143 (14.7%) reactive samples and 829 (85.3%) nonreactive samples. Sensitivity values ranged from 99.3 to 100%, and specificity was 100% for all five rapid tests. All of the rapid tests performed well, were easy to perform and yielded high scores in the operational performance analysis. Three tests, however, fulfilled all of the prerequisites established previously by the Department of STDs, AIDS and Viral Hepatitis: the HIV-1/2 3.0 Strip Test Bioeasy, the Rapid Check HIV 1 & 2 and the VIKIA HIV-1/2. Three of the five tests evaluated (the HIV-1/2 3.0 Strip Test Bioeasy, the Rapid Check HIV 1 and 2 and the VIKIA HIV-1/2) performed as well as the reference assays and fulfilled the requirements for use in the Brazilian national algorithm.

Estimation of the sensitivity and specificity of assays for screening antibodies to HIV: a comparison between the frequentist and Bayesian approaches

Bayesian and frequentist methods have been applied rarely to the same sets of data for evaluating assays for screening antibodies to HIV, especially for assays with relatively high sensitivities and/or specificities of 100% compared with reference assays. In this study, 95% confidence intervals and 95% Bayesian credible intervals were calculated for sensitivity and specificity for the evaluation of the accuracy of HIV antibody assays using data from China, WHO UNAIDS, USA, Australia, Tanzania, and India. When the sensitivity and/or specificity were 100%, a Bayesian approach obtained reasonable interval estimates of assays for screening antibodies to HIV, whereas frequentist methods express objectively the accuracy of each individual assay. It is suggested that the two types of estimates be reported simultaneously to evaluate more comprehensively a set of highly accurate antibodies for HIV assays.

Recent advances in multiplex immunoassays

The present review reports on the lastest developments in multiplex immunoassays. The selected examples are classified through their detection strategy (fluorescence, chemiluminescence, colorimetry or labeless) and their assay format (standard microtiter plate, polymeric membranes and glass slides). Finally, the degree of integration in a complete system, incorporating fluid handling and detection was also taken into account.