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Lewis JM, Macpherson P, Adams ER, Ochodo E, Sands A, Taegtmeyer M. Field accuracy of fourth-generation rapid diagnostic tests for acute HIV-1: a systematic review. AIDS 2015; 29:2465-71. [PMID: 26558545 PMCID: PMC4645957 DOI: 10.1097/qad.0000000000000855] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/11/2015] [Accepted: 08/11/2015] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Fourth-generation HIV-1 rapid diagnostic tests (RDTs) detect HIV-1 p24 antigen to screen for acute HIV-1. However, diagnostic accuracy during clinical use may be suboptimal. METHODS Clinical sensitivity and specificity of fourth-generation RDTs for acute HIV-1 were collated from field evaluation studies in adults identified by a systematic literature search. RESULTS Four studies with 17 381 participants from Australia, Swaziland, the United Kingdom and Malawi were identified. All reported 0% sensitivity of the HIV-1 p24 component for acute HIV-1 diagnosis; 26 acute infections were missed. Specificity ranged from 98.3 to 99.9%. CONCLUSION Fourth-generation RDTs are currently unsuitable for the detection of acute HIV-1.
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Affiliation(s)
- Joseph M. Lewis
- Wellcome Trust Tropical Centre
- Department of Clinical Sciences, Liverpool School of Tropical Medicine
| | - Peter Macpherson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine
- Department of Public Health and Policy, University of Liverpool
| | - Emily R. Adams
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Eleanor Ochodo
- Centre for Evidence-based Healthcare, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anita Sands
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Miriam Taegtmeyer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine
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Conway DP, Holt M, McNulty A, Couldwell DL, Smith DE, Davies SC, Cunningham P, Keen P, Guy R. Multi-centre evaluation of the Determine HIV Combo assay when used for point of care testing in a high risk clinic-based population. PLoS One 2014; 9:e94062. [PMID: 24714441 PMCID: PMC3979750 DOI: 10.1371/journal.pone.0094062] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 03/10/2014] [Indexed: 11/18/2022] Open
Abstract
Background Determine HIV Combo (DHC) is the first point of care assay designed to increase sensitivity in early infection by detecting both HIV antibody and antigen. We conducted a large multi-centre evaluation of DHC performance in Sydney sexual health clinics. Methods We compared DHC performance (overall, by test component and in early infection) with conventional laboratory HIV serology (fourth generation screening immunoassay, supplementary HIV antibody, p24 antigen and Western blot tests) when testing gay and bisexual men attending four clinic sites. Early infection was defined as either acute or recent HIV infection acquired within the last six months. Results Of 3,190 evaluation specimens, 39 were confirmed as HIV-positive (12 with early infection) and 3,133 were HIV-negative by reference testing. DHC sensitivity was 87.2% overall and 94.4% and 0% for the antibody and antigen components, respectively. Sensitivity in early infection was 66.7% (all DHC antibody reactive) and the DHC antigen component detected none of nine HIV p24 antigen positive specimens. Median HIV RNA was higher in false negative than true positive cases (238,025 vs. 37,591 copies/ml; p = 0.022). Specificity overall was 99.4% with the antigen component contributing to 33% of false positives. Conclusions The DHC antibody component detected two thirds of those with early infection, while the DHC antigen component did not enhance performance during point of care HIV testing in a high risk clinic-based population.
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Affiliation(s)
- Damian P. Conway
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- * E-mail:
| | - Martin Holt
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Deborah L. Couldwell
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney Emerging Infections and Biosecurity Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Don E. Smith
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Albion Centre, Surry Hills, Sydney, New South Wales, Australia
| | - Stephen C. Davies
- North Shore Sexual Health Service, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia
| | - Philip Cunningham
- St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
- NSW State Reference Laboratory for HIV, St Vincent's Hospital, Darlinghurst, Sydney, New South Wales, Australia
| | - Phillip Keen
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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