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Curtis KA, Rudolph DL, Pan Y, Delaney K, Anastos K, DeHovitz J, Kassaye SG, Hanson CV, French AL, Golub E, Adimora AA, Ofotokun I, Bolivar H, Kempf MC, Peters PJ, Switzer WM. Evaluation of the Abbott ARCHITECT HIV Ag/Ab combo assay for determining recent HIV-1 infection. PLoS One 2021; 16:e0242641. [PMID: 34197451 PMCID: PMC8248699 DOI: 10.1371/journal.pone.0242641] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/02/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Given the challenges and costs associated with implementing HIV-1 incidence assay testing, there is great interest in evaluating the use of commercial HIV diagnostic tests for determining recent HIV infection. A diagnostic test with the capability of providing reliable data for the determination of recent HIV infection without substantial modifications to the test protocol would have a significant impact on HIV surveillance. The Abbott ARCHITECT HIV Ag/Ab Combo Assay is an antigen/antibody immunoassay, which meets the criteria as the first screening test in the recommended HIV laboratory diagnostic algorithm for the United States. METHODS In this study, we evaluated the performance characteristics of the ARCHITECT HIV Ag/Ab Combo signal-to-cutoff ratio (S/Co) for determining recent infection, including estimation of the mean duration of recent infection (MDRI) and false recent rate (FRR), and selection of recency cutoffs. RESULTS The MDRI estimates for the S/Co recency cutoff of 400 is within the 4 to 12 months range recommended for HIV incidence assays, and the FRR rate for this cutoff was 1.5%. Additionally, ARCHITECT Combo S/Co values were compared relative to diagnostic test results from two prior prospective HIV-1 diagnostic studies in order to validate the use of the S/Co for both diagnostic and recency determination. CONCLUSION Dual-use of the ARCHITECT Combo assay data for diagnostic and incidence purposes would reduce the need for separate HIV incidence testing and allow for monitoring of recent infection for incidence estimation and other public health applications.
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Affiliation(s)
- Kelly A. Curtis
- Division of HIV/ AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Donna L. Rudolph
- Division of HIV/ AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Yi Pan
- Division of HIV/ AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kevin Delaney
- Division of HIV/ AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kathryn Anastos
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States of America
| | - Jack DeHovitz
- Downstate Medical Center, State University of New York, Brooklyn, New York, United States of America
| | - Seble G. Kassaye
- Department of Medicine / Division of Infectious Diseases, Georgetown University, Washington, DC, United States of America
| | - Carl V. Hanson
- California State Department of Health, Berkeley, California, United States of America
| | - Audrey L. French
- Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois, United States of America
| | - Elizabeth Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Igho Ofotokun
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Hector Bolivar
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Mirjam-Colette Kempf
- School of Nursing, Public Health and Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Philip J. Peters
- Division of HIV/ AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - William M. Switzer
- Division of HIV/ AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Abstract
In this chapter we will discuss the diagnosis and monitoring of individuals with HIV infection. The application and interpretation of these tests does not change dramatically when used in the immunocompromised host. The principal approach to the diagnosis of HIV infection involves serologic testing, although nucleic acid amplification tests play an important role in the diagnosis of acute HIV infection. The algorithm for diagnosis of HIV continues to evolve with newer assays that are able to detect infection within an earlier timeframe after HIV transmission. Viral load testing for HIV-1 is the cornerstone for monitoring patients on antiretroviral therapy. Genotypic and phenotypic resistance tests are employed when antiretroviral resistance is suspected and results help guide therapy. The tropism assay must be performed to determine the efficacy of CCR5 chemokine receptor antagonists. Next-generation sequencing methods are an innovative approach to assessing archived antiretroviral resistance in patients with virologic suppression. The success of antiretroviral therapy with improved long-term outcomes has made transplantation in HIV-infected patients a reality.
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Luo W, Davis G, Li L, Shriver MK, Mei J, Styer LM, Parker MM, Smith A, Paz-Bailey G, Ethridge S, Wesolowski L, Owen SM, Masciotra S. Evaluation of dried blood spot protocols with the Bio-Rad GS HIV Combo Ag/Ab EIA and Geenius™ HIV 1/2 Supplemental Assay. J Clin Virol 2017; 91:84-89. [PMID: 28366544 PMCID: PMC11111259 DOI: 10.1016/j.jcv.2017.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE FDA-approved antigen/antibody combo and HIV-1/2 differentiation supplemental tests do not have claims for dried blood spot (DBS) use. We compared two DBS-modified protocols, the Bio-Rad GS HIV Combo Ag/Ab (BRC) EIA and Geenius™ HIV-1/2 (Geenius) Supplemental Assay, to plasma protocols and evaluated them in the CDC/APHL HIV diagnostic algorithm. METHODS BRC-DBS p24 analytical sensitivity was calculated from serial dilutions of p24. DBS specimens included 11 HIV-1 seroconverters, 151 HIV-1-positive individuals, including 20 on antiretroviral therapy, 31 HIV-2-positive and one HIV-1/HIV-2-positive individuals. BRC-reactive specimens were tested with Geenius using the same DBS eluate. Matched plasma specimens were tested with BRC, an IgG/IgM immunoassay and Geenius. DBS and plasma results were compared using the McNemar's test. A DBS-algorithm applied to 348 DBS from high-risk individuals who participated in surveillance was compared to HIV status based on local testing algorithms. RESULTS BRC-DBS detects p24 at a concentration 18 times higher than in plasma. In seroconverters, BRC-DBS detected more infections than the IgG/IgM immunoassay in plasma (p=0.0133), but fewer infections than BRC-plasma (p=0.0133). In addition, the BRC/Geenius-plasma algorithm identified more HIV-1 infections than the BRC/Geenius-DBS algorithm (p=0.0455). The DBS protocols correctly identified HIV status for established HIV-1 infections, including those on therapy, HIV-2 infections, and surveillance specimens. CONCLUSIONS The DBS protocols exhibited promising performance and allowed rapid supplemental testing. Although the DBS algorithm missed some early infections, it showed similar results when applied to specimens from a high-risk population. Implementation of a DBS algorithm would benefit testing programs without capacity for venipuncture.
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Affiliation(s)
- Wei Luo
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - LiXia Li
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Joanne Mei
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Linda M Styer
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Monica M Parker
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Amanda Smith
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Steve Ethridge
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - S Michele Owen
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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de Souza MS, Pinyakorn S, Akapirat S, Pattanachaiwit S, Fletcher JLK, Chomchey N, Kroon ED, Ubolyam S, Michael NL, Robb ML, Phanuphak P, Kim JH, Phanuphak N, Ananworanich J. Initiation of Antiretroviral Therapy During Acute HIV-1 Infection Leads to a High Rate of Nonreactive HIV Serology. Clin Infect Dis 2016; 63:555-61. [PMID: 27317797 DOI: 10.1093/cid/ciw365] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/23/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Third- and fourth-generation immunoassays (IAs) are widely used in the diagnosis of human immunodeficiency virus (HIV) infection. Antiretroviral therapy (ART) during acute HIV infection (AHI) may impact HIV-specific antibodies, with failure to develop antibody or seroreversion. We report on the ability of diagnostic tests to detect HIV-specific antibodies in Thai participants initiating ART during AHI. METHODS Participants with detectable plasma HIV RNA but nonreactive HIV-specific immunoglobulin G, enrolled in an AHI study, were offered immediate initiation of ART. Participants were tested at initiation and at 12 and 24 weeks following treatment using standard second-, third-, and fourth-generation IAs and Western blot (WB). RESULTS Participants (N = 234) initiating ART at a median of 19 days (range, 1-62 days) from HIV exposure demonstrated different frequencies of reactivity prior to and following 24 weeks of ART depending on the IA. Third-generation IA nonreactivity prior to ART was 48%, which decreased to 4% following ART (P < .001). Fourth-generation IA nonreactivity was 18% prior to ART and 17% following ART (P = .720). Negative WB results were observed in 89% and 12% of participants prior to and following 24 weeks of ART, respectively (P < .001). Seroreversion to nonreactivity during ART was observed to at least one of the tests in 20% of participants, with fourth-generation IA demonstrating the highest frequency (11%) of seroreversion. CONCLUSIONS HIV-specific antibodies may fail to develop and, when detected, may decline when ART is initiated during AHI. Although fourth-generation IA was the most sensitive at detecting AHI prior to ART, third-generation IA was the most sensitive during treatment. CLINICAL TRIALS REGISTRATION NCT00796146 and NCT00796263.
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Affiliation(s)
- Mark S de Souza
- South East Asia Research Collaboration with Hawaii (SEARCH) Thai Red Cross AIDS Research Centre, Bangkok, Thailand Cooper Human Systems, Cambridge, Massachusetts
| | - Suteeraporn Pinyakorn
- Henry M. Jackson Foundation for the Advancement of Military Medicine United States Military HIV Research Program, Bethesda, Maryland
| | - Siriwat Akapirat
- Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, United States Component
| | | | | | | | - Eugene D Kroon
- South East Asia Research Collaboration with Hawaii (SEARCH) Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | - Nelson L Michael
- United States Military HIV Research Program, Bethesda, Maryland Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Merlin L Robb
- Henry M. Jackson Foundation for the Advancement of Military Medicine United States Military HIV Research Program, Bethesda, Maryland
| | - Praphan Phanuphak
- South East Asia Research Collaboration with Hawaii (SEARCH) Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Jerome H Kim
- International Vaccine Institute, Seoul, South Korea
| | - Nittaya Phanuphak
- South East Asia Research Collaboration with Hawaii (SEARCH) Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Jintanat Ananworanich
- South East Asia Research Collaboration with Hawaii (SEARCH) Henry M. Jackson Foundation for the Advancement of Military Medicine United States Military HIV Research Program, Bethesda, Maryland
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Liu MQ, Zhu ZR, Kong WH, Tang L, Peng JS, Wang X, Xu J, Schilling RF, Cai T, Zhou W. High rate of missed HIV infections in individuals with indeterminate or negative HIV western blots based on current HIV testing algorithm in China. J Med Virol 2016; 88:1462-6. [PMID: 26856240 DOI: 10.1002/jmv.24490] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2016] [Indexed: 11/12/2022]
Abstract
It remains unclear if China's current HIV antibody testing algorithm misses a substantial number of HIV infected individuals. Of 196 specimens with indeterminate or negative results on HIV western blot (WB) retrospectively examined by HIV-1 nucleic acid test (NAT), 67.57% (75/111) of indeterminate WB samples, and 16.47% (14/85) of negative WB samples were identified as NAT positive. HIV-1 loads in negative WB samples were significantly higher than those in indeterminate WB samples. Notably, 86.67% (13/15) of samples with negative WB and double positive immunoassay results were NAT positive. The rate of HIV-1 infections missed by China's current HIV testing algorithm is unacceptably high. Thus, China should consider using NAT or integrating fourth generation ELISA into current only antibodies-based HIV confirmation. J. Med. Virol. 88:1462-1466, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Man-Qing Liu
- Department of Virology, Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Ze-Rong Zhu
- Department of Virology, Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Wen-Hua Kong
- Department of Virology, Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Li Tang
- Department of Virology, Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Jin-Song Peng
- Department of Virology, Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Xia Wang
- Department of Virology, Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Jun Xu
- Department of Virology, Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Robert F Schilling
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, California
| | - Thomas Cai
- AIDS Care of China, Nanning, Guangxi, China
| | - Wang Zhou
- Department of Virology, Wuhan Centers for Disease Prevention and Control, Wuhan, China
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Maple PAC. Application of Oral Fluid Assays in Support of Mumps, Rubella and Varicella Control Programs. Vaccines (Basel) 2015; 3:988-1003. [PMID: 26690230 PMCID: PMC4693228 DOI: 10.3390/vaccines3040988] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/19/2015] [Accepted: 12/02/2015] [Indexed: 02/01/2023] Open
Abstract
Detection of specific viral antibody or nucleic acid produced by infection or immunization, using oral fluid samples, offers increased potential for wider population uptake compared to blood sampling. This methodology is well established for the control of HIV and measles infections, but can also be applied to the control of other vaccine preventable infections, and this review describes the application of oral fluid assays in support of mumps, rubella and varicella national immunization programs. In England and Wales individuals with suspected mumps or rubella, based on clinical presentation, can have an oral fluid swab sample taken for case confirmation. Universal varicella immunization of children has led to a drastic reduction of chickenpox in those countries where it is used; however, in England and Wales such a policy has not been instigated. Consequently, in England and Wales most children have had chickenpox by age 10 years; however, small, but significant, numbers of adults remain susceptible. Targeted varicella zoster virus (VZV) immunization of susceptible adolescents offers the potential to reduce the pool of susceptible adults and oral fluid determination of VZV immunity in adolescents is a potential means of identifying susceptible individuals in need of VZV vaccination. The main application of oral fluid testing is in those circumstances where blood sampling is deemed not necessary, or is undesirable, and when the documented sensitivity and specificity of the oral fluid assay methodology to be used is considered sufficient for the purpose intended.
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Affiliation(s)
- Peter A C Maple
- East Yorkshire Microbiology, Innovation Centre, York Science Park, York YO10 5DG, UK.
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Grant RM, Smith DK. Integrating Antiretroviral Strategies for Human Immunodeficiency Virus Prevention: Post- and Pre-Exposure Prophylaxis and Early Treatment. Open Forum Infect Dis 2015; 2:ofv126. [PMID: 26512356 PMCID: PMC4621406 DOI: 10.1093/ofid/ofv126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 08/15/2015] [Indexed: 01/13/2023] Open
Abstract
Best practices for integrating HIV testing and antiretroviral interventions for prevention and treatment are suggested based on research evidence and existing normative guidance. The goal is to provide high impact prevention services during periods of substantial risk. Best practices for integrating human immunodeficiency virus (HIV) testing and antiretroviral interventions for prevention and treatment are suggested based on research evidence and existing normative guidance. The goal is to provide high-impact prevention services during periods of substantial risk. Antiretroviral medications are recommended for postexposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), and treatment of HIV infection. We reviewed research evidence and current normative guidelines to identify best practices for integrating these high-impact prevention strategies. More sensitive HIV tests used for screening enable earlier diagnosis and treatment of HIV infection, more appropriate counseling, and help limit drug resistance. A fully suppressive PEP regimen should be initiated based on exposure history or physical findings when sensitive diagnostic testing is delayed or not available and antibody tests are negative. Transitions from PEP to PrEP are often warranted because HIV exposure events may continue to occur. This algorithmic approach to integrating PEP, PrEP, and early treatment decisions may increase the uptake of these interventions by a greater number and diversity of knowledgeable healthcare providers.
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Affiliation(s)
- Robert M Grant
- Gladstone Institutes and University of California , San Francisco ; San Francisco AIDS Foundation , California
| | - Dawn K Smith
- Division of HIV/AIDS Prevention , Centers for Disease Control and Prevention , Atlanta, Georgia
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Acute HIV infection: Improved algorithms for HIV testing. J Clin Virol 2015; 63:51-2. [DOI: 10.1016/j.jcv.2014.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 12/05/2014] [Accepted: 12/11/2014] [Indexed: 11/21/2022]
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Evaluation of dried blood spots with a multiplex assay for measuring recent HIV-1 infection. PLoS One 2014; 9:e107153. [PMID: 25232736 PMCID: PMC4169399 DOI: 10.1371/journal.pone.0107153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 08/12/2014] [Indexed: 11/19/2022] Open
Abstract
Laboratory-based HIV tests for recent infection (TRIs), which primarily measure a specific serological biomarker(s) that distinguishes recent from long-term HIV infection, have facilitated the estimation of population-based incidence. Dried blood spots (DBS) on filter paper are an attractive sample source for HIV surveillance, given the simplified and cost-effective methods of specimen collection, storage, and shipment. Here, we evaluated the use of DBS in conjunction with an in-house multiplex TRI, the HIV-1-specific Bio-Plex assay, which measures direct antibody binding and avidity to multiple HIV-1 analytes. The assay performance was comparable between matched plasma and DBS samples from HIV-1 infected individuals obtained from diverse sources. The coefficients of variation, comparing the median antibody reactivity for each analyte between plasma and DBS, ranged from 2.78% to 9.40% and the correlation coefficients between the two sample types ranged from 0.89 to 0.97, depending on the analyte. The correlation in antibody reactivity between laboratory and site-prepared DBS for each analyte ranged from 0.87 to 0.98 and from 0.90 to 0.97 between site-prepared DBS and plasma. The correlation in assay measures between plasma and DBS indicate that the sample types can be used interchangeably with the Bio-Plex format, without negatively impacting the misclassification rate of the assay.
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Performance of a parallel diagnostic algorithm for HIV diagnosis in low risk pediatric and obstetric patient populations. J Clin Virol 2014; 61:418-22. [PMID: 25193614 DOI: 10.1016/j.jcv.2014.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 08/07/2014] [Accepted: 08/10/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Little is known about the clinical performance of the 2010 APHL/CDC Western-blot independent HIV testing algorithm in low risk pediatric and obstetric patients. OBJECTIVE To evaluate the performance of an alternate Western-blot independent algorithm and the individual algorithm components in diagnosing HIV infections in low risk pediatric and obstetric patients. STUDY DESIGN 6242 specimens from pediatric and obstetric patients were tested by the Bio-Rad Multispot HIV-1/HIV-2 (MS) and VITROS Anti HIV 1+2 (VITROS) assays. 913 specimens were also tested by the ARCHITECT HIV Ag/Ab Combo assay (ARCHITECT). Discordant specimens were tested by the APTIMA HIV-1 RNA qualitative assay (RNA Qual). RESULTS Twenty-eight specimens tested positive for HIV-1 by both MS and VITROS, 4 of these 28 specimens were also tested by and positive by ARCHITECT; all 28 positives identified by the algorithm were positive by viral load analysis. MS identified 164 preliminary positives, which were not confirmed as true positives, representing a specificity of 97.4%. This specificity varied between patient populations (96.1% in the pediatric population and 99.1% in the obstetric population). The specificities of VITROS and ARCHITECT were 99.2% and 99.4% for pediatric patients; 99.7% and 99.8% for obstetric patients, respectively. CONCLUSION Our results highlight suboptimal specificity of MS in pediatric patients, and a lower specificity in both pediatric and obstetric patients relative to either VITROS or ARCHITECT. Additionally, parallel testing with both a third and fourth generation EIA in a low risk patient population provides a potential alternative to Western-blot dependent algorithms for confirmation.
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Wood BR, Ballenger C, Stekler JD. Arguments for and against HIV self-testing. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2014; 6:117-26. [PMID: 25114592 PMCID: PMC4126574 DOI: 10.2147/hiv.s49083] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Approximately 60% of human immunodeficiency virus (HIV)-infected individuals are unaware of their infection, and stigma and discrimination continue to threaten acceptance of HIV testing services worldwide. Self-testing for HIV has garnered controversy for years and the debate reignited with the approval of a point-of-care test for over-the-counter sale in the US in 2012. Here, we present arguments for and against HIV self-testing. The case in support of HIV self-testing contends that: the modality is highly acceptable, especially among the most at-risk individuals; self-testing empowers users, thus helping to normalize testing; and mutual partner testing has the potential to increase awareness of risk and avert condomless sex between discordant partners. Arguments against HIV self-testing include: cost limits access to those who need testing most; false-negative results, especially during the window period, may lead to false reassurance and could promote sex between discordant partners at the time of highest infectivity; opportunities for counseling, linkage to care, and diagnosis of other sexually transmitted infections may be missed; and self-testing leads to potential for coercion between partners. Research is needed to better define the risks of self-testing, especially as performance of the assays improves, and to delineate the benefits of programs designed to improve access to self-test kits, because this testing modality has numerous potential advantages and drawbacks.
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Affiliation(s)
- Brian R Wood
- Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | - Carl Ballenger
- Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | - Joanne D Stekler
- Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA ; Public Health, Seattle and King County HIV/STD Program, Seattle, WA, USA
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Krajden M, Cook D, Mak A, Chu K, Chahil N, Steinberg M, Rekart M, Gilbert M. Pooled nucleic acid testing increases the diagnostic yield of acute HIV infections in a high-risk population compared to 3rd and 4th generation HIV enzyme immunoassays. J Clin Virol 2014; 61:132-7. [PMID: 25037533 DOI: 10.1016/j.jcv.2014.06.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 06/20/2014] [Accepted: 06/24/2014] [Indexed: 01/14/2023]
Abstract
OBJECTIVES We compared a 3rd generation (gen) and two 4th gen HIV enzyme immunoassays (EIA) to pooled nucleic acid testing (PNAT) for the identification of pre- and early seroconversion acute HIV infection (AHI). STUDY DESIGN 9550 specimens from males >18 year from clinics attended by men who have sex with men were tested by Siemens ADVIA Centaur(®) HIV 1/O/2 (3rd gen) and HIV Combo (4th gen), as well as by Abbott ARCHITECT(®) HIV Ag/Ab Combo (4th gen). Third gen non-reactive specimens were also tested by Roche COBAS(®) Ampliprep/COBAS® TaqMan HIV-1 Test v.2 in pools of 24 samples. Sensitivity and specificity of the three EIAs for AHI detection were compared. RESULTS 7348 persons contributed 9435 specimens and had no evidence of HIV infection, 79 (94 specimens) had established HIV infection, 6 (9 specimens) had pre-seroconversion AHI and 9 (12 specimens) had early seroconversion AHI. Pre-seroconversion AHI cases were not detected by 3rd gen EIA, whereas 2/6 (33.3%) were detected by Siemens 4th gen, 4/6 (66.7%) by Abbott 4th gen and 6/6 (100%) by PNAT. All three EIAs and PNAT detected all individuals with early seroconversion AHI. Overall sensitivity/specificity for the EIAs relative to WB or NAT resolved infection status was 93.6%/99.9% for Siemens 3rd gen, 95.7%/99.7% for Siemens 4th gen and 97.9%/99.2% for Abbott 4th gen. CONCLUSIONS While both 4th gen EIAs demonstrated improved sensitivity for AHI compared to 3rd gen EIA, PNAT identified more AHI cases than either 4th gen assay. PNAT is likely to remain a useful strategy to identify AHI in high-risk populations.
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Affiliation(s)
- Mel Krajden
- Clinical Prevention Services, BC Centre for Disease Control, 655 West 12th Ave, Vancouver, BC V5Z 4R4, Canada; Faculty of Medicine, University of British Columbia, 2194 Health Sciences Mall, Vancouver, BC V6 T 1Z3, Canada; Public Health Microbiology & Reference Laboratory, BC Centre for Disease Control, 655 West 12th Ave Vancouver, BC V5Z 4R4, Canada.
| | - Darrel Cook
- Clinical Prevention Services, BC Centre for Disease Control, 655 West 12th Ave, Vancouver, BC V5Z 4R4, Canada
| | - Annie Mak
- Public Health Microbiology & Reference Laboratory, BC Centre for Disease Control, 655 West 12th Ave Vancouver, BC V5Z 4R4, Canada
| | - Ken Chu
- Public Health Microbiology & Reference Laboratory, BC Centre for Disease Control, 655 West 12th Ave Vancouver, BC V5Z 4R4, Canada
| | - Navdeep Chahil
- Public Health Microbiology & Reference Laboratory, BC Centre for Disease Control, 655 West 12th Ave Vancouver, BC V5Z 4R4, Canada
| | - Malcolm Steinberg
- Clinical Prevention Services, BC Centre for Disease Control, 655 West 12th Ave, Vancouver, BC V5Z 4R4, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Michael Rekart
- Faculty of Medicine, University of British Columbia, 2194 Health Sciences Mall, Vancouver, BC V6 T 1Z3, Canada
| | - Mark Gilbert
- Clinical Prevention Services, BC Centre for Disease Control, 655 West 12th Ave, Vancouver, BC V5Z 4R4, Canada; Faculty of Medicine, University of British Columbia, 2194 Health Sciences Mall, Vancouver, BC V6 T 1Z3, Canada
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