51
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Branson BM. HIV Diagnostics: Current Recommendations and Opportunities for Improvement. Infect Dis Clin North Am 2019; 33:611-628. [PMID: 31239094 DOI: 10.1016/j.idc.2019.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Profound changes in technology have revolutionized laboratory testing for human immunodeficiency virus (HIV) since the first laboratory enzyme immunoassays that detected only immunoglobulin G (IgG) antibodies. Instrumented fourth-generation random-access chemiluminescent assays are now recommended for initial screening because they become reactive in as little as 2 weeks after infection. Using HIV-1 RNA viral load assays after a reactive initial test could confirm infection and provide useful clinical information. Early initiation of antiretroviral therapy and use of preexposure prophylaxis can alter the evolution of biomarkers and assay reactivity, leading to ambiguous test results.
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Affiliation(s)
- Bernard M Branson
- Scientific Affairs LLC, 2175 Eldorado Drive, Atlanta, GA 30345, USA.
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52
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A generalizable method for estimating duration of HIV infections using clinical testing history and HIV test results. AIDS 2019; 33:1231-1240. [PMID: 30870196 DOI: 10.1097/qad.0000000000002190] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine the precision of new and established methods for estimating duration of HIV infection. DESIGN A retrospective analysis of HIV testing results from serial samples in commercially available panels, taking advantage of extensive testing previously conducted on 53 seroconverters. METHODS We initially investigated four methods for estimating infection timing: method 1, 'Fiebig stages' based on test results from a single specimen; method 2, an updated '4th gen' method similar to Fiebig stages but using antigen/antibody tests in place of the p24 antigen test; method 3, modeling of 'viral ramp-up' dynamics using quantitative HIV-1 viral load data from antibody-negative specimens; and method 4, using detailed clinical testing history to define a plausible interval and best estimate of infection time. We then investigated a 'two-step method' using data from both methods 3 and 4, allowing for test results to have come from specimens collected on different days. RESULTS Fiebig and '4th gen' staging method estimates of time since detectable viremia had similar and modest correlation with observed data. Correlation of estimates from both new methods (3 and 4), and from a combination of these two ('two-step method') was markedly improved and variability significantly reduced when compared with Fiebig estimates on the same specimens. CONCLUSION The new 'two-step' method more accurately estimates timing of infection and is intended to be generalizable to more situations in clinical medicine, research, and surveillance than previous methods. An online tool is now available that enables researchers/clinicians to input data related to method 4, and generate estimated dates of detectable infection.
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53
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Albitar HAH, Abu Saleh OM. Pneumocystis Pneumonia Complicated by Extensive Diffuse Pneumatoceles. Am J Med 2019; 132:e562-e563. [PMID: 30659808 DOI: 10.1016/j.amjmed.2018.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/06/2018] [Accepted: 12/21/2018] [Indexed: 11/16/2022]
Affiliation(s)
| | - Omar M Abu Saleh
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
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54
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Curtis KA, Campbell EM, Hanson DL, Rudolph DL, Duwve J, Blosser S, Gentry J, Lovchik J, Peters PJ, Owen SM, Switzer WM. A Multiplex HIV Incidence Assay for Inferring Recent HIV-1 Transmission and Time of Infection. J Acquir Immune Defic Syndr 2019; 80:454-460. [PMID: 30624297 PMCID: PMC11342239 DOI: 10.1097/qai.0000000000001937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laboratory assays for determining recent HIV-1 infection are an important public health tool for aiding in the estimation of HIV incidence. Some incidence assay analytes are remarkably predictive of time since seroconversion and may be useful for additional applications, such as predicting recent transmission events during HIV outbreaks and informing prevention strategies. METHODS Plasma samples (n = 154) from a recent HIV-1 outbreak in a rural community in Indiana were tested with the customized HIV-1 Multiplex assay, based on the Bio-Rad Bio-Plex platform, which measures antibody response to HIV envelope antigens, gp120, gp160, and gp41. Assay cutoffs for each analyte were established to determine whether an individual seroconverted within 30, 60, or 90 days of the sample collection date. In addition, a novel bioinformatics method was implemented to infer infection dates of persons newly diagnosed with HIV during the outbreak. RESULTS Sensitivity/specificity of the HIV-1 Multiplex assay for predicting seroconversion within 30, 60, and 90 days, based on a training data set, was 90.5%/95.4%, 94.1%/90%, and 89.4%/82.9%, respectively. Of 154 new diagnoses in Indiana between December 2014 and August 2016, the majority (71%) of recent infections (≤3 months since seroconversion) were identified between February and May 2016. The epidemiologic curve derived from the bioinformatics analysis indicated HIV transmission began as early as 2010, grew exponentially in 2014, and leveled off in April 2015. CONCLUSIONS The HIV-1 Multiplex assay has the potential to identify and monitor trends in recent infection during an epidemic to assess the efficacy of programmatic or treatment interventions.
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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, GA
| | - Ellsworth M. Campbell
- Division of HIV/ AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Debra L. Hanson
- Division of HIV/ AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - 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, GA
| | - Joan Duwve
- Indiana State Department of Health, Indianapolis, IN
- Indiana University, Bloomington, IN
| | - Sara Blosser
- Indiana State Department of Health, Indianapolis, IN
| | | | - Judy Lovchik
- Indiana State Department of Health, Indianapolis, IN
| | - 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, GA
| | - S. Michele Owen
- Division of HIV/ AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - 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, GA
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55
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Characteristics of deceased solid organ donors and screening results for hepatitis B, C, and human immunodeficiency viruses — United States, 2010–2017. Am J Transplant 2019. [DOI: 10.1111/ajt.15284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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56
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Abara WE, Collier MG, Moorman A, Bixler D, Jones J, Annambhotla P, Bowman J, Levi ME, Brooks JT, Basavaraju SV. Characteristics of Deceased Solid Organ Donors and Screening Results for Hepatitis B, C, and Human Immunodeficiency Viruses - United States, 2010-2017. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:61-66. [PMID: 30677008 PMCID: PMC6348762 DOI: 10.15585/mmwr.mm6803a2] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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57
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Dashwood T, Tan DHS. PrEParing for the unexpected: mechanisms and management of HIV pre-exposure prophylaxis failure. Future Virol 2018. [DOI: 10.2217/fvl-2018-0084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pre-exposure prophylaxis (PrEP) for HIV is a proven and effective tool for preventing HIV. However, there are instances where individuals taking PrEP have contracted HIV infection. Most of these cases are due to nonadherence to the drug, while other cases of apparent PrEP failure are due to unrecognized HIV infection at baseline. Importantly, there are also now at least three well-documented cases of PrEP failing despite adequate adherence; these are cases of PrEP ‘breakthrough’. This article outlines the potential mechanisms of PrEP failure, as well as how to identify and manage these patients. Finally, we provide a perspective on the future of PrEP as a key tool in preventing HIV worldwide.
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Affiliation(s)
- Thomas Dashwood
- Department of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Darrell HS Tan
- Department of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada
- Division of Infectious Diseases, St Michael's Hospital, Toronto, ON M5B 1W8, Canada
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON M5B 1W8, Canada
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
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58
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Stekler JD, Violette LR, Niemann L, McMahan VM, Katz DA, Baeten JM, Grant RM, Delaney KP. Repeated False-Positive HIV Test Results in a Patient Taking HIV Pre-Exposure Prophylaxis. Open Forum Infect Dis 2018; 5:ofy197. [PMID: 30276221 PMCID: PMC6157305 DOI: 10.1093/ofid/ofy197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/18/2018] [Indexed: 11/23/2022] Open
Abstract
Regular HIV testing is required to ensure the safety of HIV pre-exposure prophylaxis (PrEP). We describe and discuss a series of false-positive HIV test results from an individual receiving PrEP. The expansion of PrEP will likely result in greater numbers of false-positive test results that may pose challenges for interpretation.
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Affiliation(s)
- Joanne D Stekler
- Departments of 1Medicine, University of Washington, Seattle, Washington.,Epidemiology, University of Washington, Seattle, Washington.,Global Health, University of Washington, Seattle, Washington
| | - Lauren R Violette
- Departments of 1Medicine, University of Washington, Seattle, Washington
| | - Lisa Niemann
- Departments of 1Medicine, University of Washington, Seattle, Washington
| | - Vanessa M McMahan
- Departments of 1Medicine, University of Washington, Seattle, Washington
| | - David A Katz
- Departments of 1Medicine, University of Washington, Seattle, Washington.,HIV/STD Program, Public Health - Seattle & King County, Washington
| | - Jared M Baeten
- Departments of 1Medicine, University of Washington, Seattle, Washington.,Epidemiology, University of Washington, Seattle, Washington.,Global Health, University of Washington, Seattle, Washington
| | | | - Kevin P Delaney
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
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59
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Gray ER, Bain R, Varsaneux O, Peeling RW, Stevens MM, McKendry RA. p24 revisited: a landscape review of antigen detection for early HIV diagnosis. AIDS 2018; 32:2089-2102. [PMID: 30102659 PMCID: PMC6139023 DOI: 10.1097/qad.0000000000001982] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
: Despite major advances in HIV testing, early detection of infection at the point of care (PoC) remains a key challenge. Although rapid antibody PoC and laboratory-based nucleic acid amplification tests dominate the diagnostics market, the viral capsid protein p24 is recognized as an alternative early virological biomarker of infection. However, the detection of ultra-low levels of p24 at the PoC has proven challenging. Here we review the landscape of p24 diagnostics to identify knowledge gaps and barriers and help shape future research agendas. Five hundred and seventy-four research articles to May 2018 that propose or evaluate diagnostic assays for p24 were identified and reviewed. We give a brief history of diagnostic development, and the utility of p24 as a biomarker in different populations such as infants, the newly infected, those on preexposure prophylaxis and self-testers. We review the performance of commercial p24 assays and consider elements such as immune complex disruption, resource-poor settings, prevalence, and assay antibodies. Emerging and ultrasensitive assays are reviewed and show a number of promising approaches but further translation has been limited. We summarize studies on the health economic benefits of using antigen testing. Finally, we speculate on the future uses of high-performance p24 assays, particularly, if available in self-test format.
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Affiliation(s)
- Eleanor R Gray
- London Centre for Nanotechnology, Faculty of Maths and Physical Sciences, University College London
| | - Robert Bain
- Department of Materials, Department of Bioengineering and Institute of Biomedical Engineering, Imperial College London
| | | | | | - Molly M Stevens
- Department of Materials, Department of Bioengineering and Institute of Biomedical Engineering, Imperial College London
| | - Rachel A McKendry
- London Centre for Nanotechnology, Faculty of Maths and Physical Sciences, University College London
- Division of Medicine, University College London, London, UK
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60
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Stekler JD, Tapia K, Maenza J, Stevens CE, Ure GA, O'Neal JD, Lane A, Mullins JI, Coombs RW, Holte S, Collier AC. No Time to Delay! Fiebig Stages and Referral in Acute HIV infection: Seattle Primary Infection Program Experience. AIDS Res Hum Retroviruses 2018; 34:657-666. [PMID: 29756456 DOI: 10.1089/aid.2017.0276] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There has been increasing recognition of the importance of diagnosing individuals during the earliest stages of human immunodeficiency virus (HIV) infection. Sera from individuals referred to a primary HIV infection research program were screened using the IgG-sensitive Vironostika HIV-1 Microelisa System, IgG/IgM-sensitive GS HIV-1/HIV-2 Plus O antibody enzyme immunoassay (EIA), or Abbott ARCHITECT HIV antigen (Ag)/antibody (Ab) Combo assay and confirmed by the Bio-Rad Multispot and Western blot. A subset of participants was co-enrolled in a study designed to compare the ability of point-of-care tests to detect early infection. We calculated time within primary infection laboratory stages using actual observed transitions and with an expectation-maximization algorithm. Three hundred and sixty participants contributed data to this analysis. Of 123 persons referred with EIA-negative/RNA-positive test results (Fiebig stage I-II) or for concern for symptoms, 24 (20%) were still in stages I-II, and 99 (80%) were in stages III or later at their screening visit. Participants were estimated to spend a median of 13.5 days in stages I and II, 2.3 days in stage III, and 7.8 days in stage IV. OraQuick performed on oral fluids detected 53% of 17 participants in stage V. The durations of stages we observed are consistent with previous publications. Most persons referred for research no longer had acute infection at their first visit. Programs wishing to identify persons in the very earliest stages of infection need to expedite referrals or develop targeted screening programs.
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Affiliation(s)
- Joanne D. Stekler
- Department of Medicine, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Global Health, University of Washington, Seattle, Washington
| | - Kenneth Tapia
- Department of Global Health, University of Washington, Seattle, Washington
| | - Janine Maenza
- Department of Medicine, University of Washington, Seattle, Washington
| | - Claire E. Stevens
- Department of Medicine, University of Washington, Seattle, Washington
| | - George A. Ure
- Department of Medicine, University of Washington, Seattle, Washington
| | | | - Aric Lane
- Department of Medicine, University of Washington, Seattle, Washington
| | - James I. Mullins
- Department of Medicine, University of Washington, Seattle, Washington
- Department of Microbiology, University of Washington, Seattle, Washington
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Robert W. Coombs
- Department of Medicine, University of Washington, Seattle, Washington
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Sarah Holte
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ann C. Collier
- Department of Medicine, University of Washington, Seattle, Washington
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Comparison of Detection Limits of Fourth- and Fifth-Generation Combination HIV Antigen-Antibody, p24 Antigen, and Viral Load Assays on Diverse HIV Isolates. J Clin Microbiol 2018; 56:JCM.02045-17. [PMID: 29793968 DOI: 10.1128/jcm.02045-17] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/04/2018] [Indexed: 12/18/2022] Open
Abstract
Detection of acute HIV infection is critical for HIV public health and diagnostics. Clinical fourth-generation antigen (Ag)/antibody (Ab) combination (combo) and p24 Ag immunoassays have enhanced detection of acute infection compared to Ab-alone assays but require ongoing evaluation with currently circulating diverse subtypes. Genetically and geographically diverse HIV clinical isolates were used to assess clinical HIV diagnostic, blood screening, and next-generation assays. Three-hundred-member panels of 20 serially diluted well-characterized antibody-negative HIV isolates for which the researchers were blind to the results (blind panels) were distributed to manufacturers and end-user labs to assess the relative analytic sensitivity of currently approved and preapproved clinical HIV fourth-generation Ag/Ab combo or p24 Ag-alone immunoassays for the detection of diverse subtypes. The limits of detection (LODs) of virus were estimated for different subtypes relative to confirmed viral loads. Analysis of immunoassay sensitivity was benchmarked against confirmed viral load measurements on the blind panel. On the basis of the proportion of positive results on 300 observations, all Ag/Ab combo and standard sensitivity p24 Ag assays performed similarly and within half-log LODs, illustrating the similar breadth of reactivity and diagnostic utility. Ultrasensitive p24 Ag assays achieved dramatically increased sensitivities, while the rapid combo assays performed poorly. The similar performance of the different commercially available fourth-generation assays on diverse subtypes supports their use in broad geographic settings with locally circulating HIV clades and recombinant strains. Next-generation preclinical ultrasensitive p24 Ag assays achieved dramatically improved sensitivity, while rapid fourth-generation assays performed poorly for p24 Ag detection.
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62
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Smith DK, Switzer WM, Peters P, Delaney KP, Granade TC, Masciotra S, Shouse L, Brooks JT. A Strategy for PrEP Clinicians to Manage Ambiguous HIV Test Results During Follow-up Visits. Open Forum Infect Dis 2018; 5:ofy180. [PMID: 30568989 DOI: 10.1093/ofid/ofy180] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 07/19/2018] [Indexed: 11/12/2022] Open
Abstract
Prompt determination of HIV infection status is critical during follow-up visits for patients taking pre-exposure prophylaxis (PrEP) medication. Those who are uninfected can then continue safely taking PrEP, and those few who have acquired HIV infection can initiate an effective treatment regimen. However, a few recent cases have been reported of ambiguous HIV test results using common testing algorithms in PrEP patients. We review published reports of such cases and testing options that can be used to clarify true HIV status in these situations. In addition, we review the benefits and risks of 3 antiretroviral management options in these patients: (1) continue PrEP while conducting additional HIV tests, (2) initiate antiretroviral therapy for presumptive HIV infection while conducting confirmatory tests, or (3) discontinue PrEP to reassess HIV status after a brief antiretroviral-free interval. A clinical consultation resource is also provided.
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Affiliation(s)
- Dawn K Smith
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, Atlanta, Georgia.,TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William M Switzer
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, Atlanta, Georgia.,TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Philip Peters
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, Atlanta, Georgia.,TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kevin P Delaney
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, Atlanta, Georgia.,TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Timothy C Granade
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, Atlanta, Georgia.,TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Silvina Masciotra
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, Atlanta, Georgia.,TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Luke Shouse
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, Atlanta, Georgia.,TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John T Brooks
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, Atlanta, Georgia.,TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Parker MM, Bennett SB, Sullivan TJ, Fordan S, Wesolowski LG, Wroblewski K, Gaynor AM. Performance of the Alere Determine™ HIV-1/2 Ag/Ab Combo Rapid Test with algorithm-defined acute HIV-1 infection specimens. J Clin Virol 2018; 104:89-91. [PMID: 29803089 PMCID: PMC11013022 DOI: 10.1016/j.jcv.2018.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/09/2018] [Accepted: 05/12/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND The capacity of HIV Antigen/Antibody (Ag/Ab) immunoassays (IA) to detect HIV-1 p24 antigen has resulted in improved detection of HIV-1 infections in comparison to Ab-only screening assays. Since its introduction in the US, studies have shown that the Determine HIV-1/2 Ag/Ab Combo assay (Determine Ag/Ab) detects HIV infection earlier than laboratory-based IgM/IgG-sensitive IAs, but its sensitivity for HIV-1 p24 Ag detection is reduced compared to laboratory-based Ag/Ab assays. However, further evaluation is needed to assess its capacity to detect acute HIV-1 infection. OBJECTIVE To assess the performance of Determine Ag/Ab in serum from acute HIV-1 infections. STUDY DESIGN Select serum specimens that screened reactive on a laboratory-based Ag/Ab IA or IgM/IgG Ab-only IA, with a negative or indeterminate supplemental antibody test and detectable HIV-1 RNA were retrospectively tested with Determine Ag/Ab. Results were compared with those of the primary screening immunoassay to evaluate concordance within this set of algorithm-defined acute infections. RESULTS Of 159 algorithm-defined acute HIV-1 specimens, Determine Ag/Ab was reactive for 105 resulting in 66.0% concordance. Of 125 that were initially detected by a laboratory-based Ag/Ab IA, 81 (64.8%) were reactive by Determine Ag/Ab. A total of 34 acute specimens were initially detected by a laboratory-based IgM/IgG Ab-only IA and 24 (70.6%) of those were reactive by Determine Ag/Ab. CONCLUSIONS Due to their enhanced sensitivity, laboratory-based Ag/Ab IAs continue to be preferred over the Determine Ag/Ab as the screening method used by laboratories conducting HIV diagnostic testing on serum and plasma specimens.
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Affiliation(s)
- Monica M Parker
- Wadsworth Center, New York State Department of Health, 120 New Scotland Avenue, Albany, NY, 12208, United States.
| | - S Berry Bennett
- Florida Bureau of Public Health Laboratories, 1217 Pearl St., Jacksonville, FL, 32202, United States.
| | - Timothy J Sullivan
- Wadsworth Center, New York State Department of Health, 120 New Scotland Avenue, Albany, NY, 12208, United States.
| | - Sally Fordan
- Florida Bureau of Public Health Laboratories, 1217 Pearl St., Jacksonville, FL, 32202, United States.
| | | | - Kelly Wroblewski
- Association of Public Health Laboratories, 8515 Georgia Ave., Suite 700, Silver Spring, MD, 20910, United States.
| | - Anne M Gaynor
- Association of Public Health Laboratories, 8515 Georgia Ave., Suite 700, Silver Spring, MD, 20910, United States.
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John SA, Rendina HJ, Grov C, Parsons JT. Home-based pre-exposure prophylaxis (PrEP) services for gay and bisexual men: An opportunity to address barriers to PrEP uptake and persistence. PLoS One 2017; 12:e0189794. [PMID: 29281688 PMCID: PMC5744975 DOI: 10.1371/journal.pone.0189794] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 12/02/2017] [Indexed: 11/18/2022] Open
Abstract
Gay, bisexual, and other men who have sex with men (GBM) are disproportionately affected by the HIV epidemic. Despite the promise of pre-exposure prophylaxis (PrEP) in reducing HIV transmission risk, barriers for uptake and persistence exist. We sought to identify whether GBM in a nationwide cohort who have not yet initiated PrEP (n = 906) would prefer to get PrEP-related care from a primary care provider (PCP) compared to a specialist clinic or provider. We then sought to identify their level of interest and factors associated with preference for using home-based PrEP services (i.e., HB-PrEP), defined to participants as conducting HIV/STI self-testing from home with PrEP prescription mailing after an initial in-person clinic visit. We examined the associations of demographics, sexual HIV transmission risk, concern about frequent medical checkups associated with PrEP, health care access, and PrEP intentions with preferences for healthcare provider type and HB-PrEP. Concern about frequent medical checkups were associated with preferring a PCP for PrEP-related care, but men who perceived a barrier to bringing up the topic of PrEP with a doctor preferred a specialist clinic or provider more than a PCP. HB-PrEP was more appealing for younger men and those engaged in sexual HIV transmission risk, suggesting HB-PrEP could help reach GBM most vulnerable to HIV and in need of PrEP. HB-PrEP expansion has potential to increase PrEP uptake and persistence among GBM, particularly for men with barriers to clinic-based care and higher intentions to initiate PrEP. Clinical guidelines regarding HB-PrEP are needed to expand its use.
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Affiliation(s)
- Steven A John
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, United States of America
| | - H Jonathon Rendina
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, United States of America.,Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, United States of America.,Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, United States of America
| | - Christian Grov
- CUNY Graduate School of Public Health and Health Policy, New York, NY, United States of America
| | - Jeffrey T Parsons
- Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY, United States of America.,Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, United States of America.,Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, United States of America
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65
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Hurt CB, Nelson JAE, Hightow-Weidman LB, Miller WC. Selecting an HIV Test: A Narrative Review for Clinicians and Researchers. Sex Transm Dis 2017; 44:739-746. [PMID: 29140890 PMCID: PMC5718364 DOI: 10.1097/olq.0000000000000719] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Given the many options available, selecting an HIV test for a particular clinical or research setting can be daunting. Making an informed decision requires an assessment of the likelihood of acute infection in the test population and an understanding of key aspects of the tests themselves. The ability of individual tests to reliably detect HIV infection depends on the target(s) being detected, when they can be expected to be present after infection, and the concentration of stable target in test specimens, all of which are explained by the virologic and serologic events after infection. The purpose of this article is to review the timeline of HIV infection, nomenclature, and characteristics of different tests; compare point-of-care and laboratory-based tests; discuss the impact of different specimens on test performance; and provide practical advice to help clinicians and researchers new to the field select a test that best suits their needs.
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Affiliation(s)
- Christopher B Hurt
- From the *Institute for Global Health and Infectious Diseases, †Behavior and Technology Lab, and ‡Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC; and §Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH
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Hargrove JW, van Schalkwyk C, Humphrey JH, Mutasa K, Ntozini R, Owen SM, Masciotra S, Parekh BS, Duong YT, Dobbs T, Kilmarx PH, Gonese E. Short Communication: Heightened HIV Antibody Responses in Postpartum Women as Exemplified by Recent Infection Assays: Implications for Incidence Estimates. AIDS Res Hum Retroviruses 2017; 33:902-904. [PMID: 28443672 DOI: 10.1089/aid.2016.0319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Laboratory assays that identify recent HIV infections are important for assessing impacts of interventions aimed at reducing HIV incidence. Kinetics of HIV humoral responses can vary with inherent assay properties, and between HIV subtypes, populations, and physiological states. They are important in determining mean duration of recent infection (MDRI) for antibody-based assays for detecting recent HIV infections. We determined MDRIs for multi-subtype peptide representing subtypes B, E and D (BED)-capture enzyme immunoassay, limiting antigen (LAg), and Bio-Rad Avidity Incidence (BRAI) assays for 101 seroconverting postpartum women, recruited in Harare from 1997 to 2000 during the Zimbabwe Vitamin A for Mothers and Babies trial, comparing them against published MDRIs estimated from seroconverting cases in the general population. We also compared MDRIs for women who seroconverted either during the first 9 months, or at later stages, postpartum. At cutoffs (C) of 0.8 for BED, 1.5 for LAg, and 40% for BRAI, estimated MDRIs for postpartum mothers were 192, 104, and 144 days, 33%, 32%, and 52% lower than published estimates of 287, 152 and 298 days, respectively, for clade C samples from general populations. Point estimates of MDRI values were 7%-19% shorter for women who seroconverted in the first 9 months postpartum than for those seroconverting later. MDRI values for three HIV incidence biomarkers are longer in the general population than among postpartum women, particularly those who recently gave birth, consistent with heightened immunological activation soon after birth. Our results provide a caution that MDRI may vary significantly between subjects in different physiological states.
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Affiliation(s)
- John W. Hargrove
- The South African DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, Stellenbosch, South Africa
| | - Cari van Schalkwyk
- The South African DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, Stellenbosch, South Africa
| | - Jean H. Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Sherry Michele Owen
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Silvina Masciotra
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bharat S. Parekh
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yen T. Duong
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Trudy Dobbs
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Peter H. Kilmarx
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Elizabeth Gonese
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Harare, Zimbabwe
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Boukli N, Boyd A, Wendremaire N, Girard PM, Bottero J, Morand-Joubert L. Sensitivity of the STAT-VIEW rapid self-test and implications for use during acute HIV infection. Sex Transm Infect 2017; 94:475-478. [PMID: 28835532 DOI: 10.1136/sextrans-2017-053131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/10/2017] [Accepted: 07/30/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES HIV testing is an important step towards diminishing incident infections. Rapid self-tests whose use is becoming more common in France could help increase access to testing, yet could fail to diagnose HIV during acute HIV infection (AHI). The aim of the present study was to evaluate HIV-detection sensitivity of a commonly used rapid self-test (STAT-VIEW HIV1/2), compared with another point-of-care rapid test (INSTI), among patients presenting with AHI. METHODS Individuals tested at Saint-Antoine Hospital (Paris, France) with negative or indeterminate western blot (WB) results and detectable HIV-RNA were included. Rapid tests were performed retrospectively on stored serum. Patients with and without reactive rapid tests were compared, while probability of having a reactive test was modelled across infection duration using logistic regression. RESULTS Of the 40 patients with AHI, 23 (57.5%) had a reactive STAT-VIEW rapid test. Patients with non-reactive versus reactive tests had a significantly shorter median time since infection (p=0.01), time since onset of symptoms (p=0.009), higher proportion with Fiebig stage III versus IV (p=0.003), negative WB results (p=0.007), higher HIV-RNA levels (p=0.001) and lower CD4+ and CD8+ cell count (p=0.03, p<0.001, respectively). When examining sensitivity over the course of AHI duration, the probability of HIV detection was 75.5% at 5 weeks from HIV transmission. The INSTI provided similar results with respect to proportion of reactive tests (62.5%), determinants for non-reactive test and probability of HIV detection at 5 weeks of infection (85.0%). CONCLUSIONS Over half of AHI patients had reactive serology using the STAT-VIEW rapid self-test when performed on serum samples. Considering that detection sensitivity increased substantially over infection time, individuals should not rely on a negative result to accurately exclude HIV infection within at least 5 weeks of potential HIV exposure. Notwithstanding strong recommendations against rapid test use during AHI, some utility in detecting HIV is observed 5-12 weeks after transmission.
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Affiliation(s)
- Narjis Boukli
- AP-HP, Centre Hospitalo-Universitaire Saint-Antoine, Laboratoire de Virologie, Paris, France
| | - Anders Boyd
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Noémie Wendremaire
- AP-HP, Centre Hospitalo-Universitaire Saint-Antoine, Laboratoire de Virologie, Paris, France
| | - Pierre-Marie Girard
- AP-HP, Centre Hospitalo-Universitaire Saint-Antoine, Service de Maladies Infectieuses, Paris, France.,Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, Paris, France
| | - Julie Bottero
- AP-HP, Centre Hospitalo-Universitaire Saint-Antoine, Service de Maladies Infectieuses, Paris, France.,Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, Paris, France
| | - Laurence Morand-Joubert
- AP-HP, Centre Hospitalo-Universitaire Saint-Antoine, Laboratoire de Virologie, Paris, France.,Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, Paris, France
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70
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A multiplex assay for detection of SHIV plasma and mucosal IgG and IgA. J Immunol Methods 2017; 450:34-40. [PMID: 28750871 DOI: 10.1016/j.jim.2017.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/13/2017] [Accepted: 07/24/2017] [Indexed: 11/24/2022]
Abstract
Evaluating antibody maturation provides valuable data to characterize immune responses to HIV infection and can provide insight into biomedical intervention efficacy. It is important to develop assays that evaluate antibody maturation in both plasma and mucosal compartments. The nonhuman primate model provides a controlled system to collect temporal data that are integral to assessing intervention strategies. We report the development of a novel multiplex assay, based on the Bio-Plex platform, to evaluate plasma and mucosal IgG and IgA avidity and maturation against simian/human immunodeficiency virus (SHIV) in this controlled system. Vaginal mucosa and plasma samples were collected from a prior study evaluating the efficacy of a tenofovir disoproxil fumarate (TDF) intravaginal ring (IVR) against SHIVSF162P3 challenge in female pigtailed macaques. For validation of the multiplex assay, specimens from six SHIV-infected placebo animals and one TDF breakthrough animal were evaluated. For SHIV and HIV envelope analytes, antibody levels and avidity in both compartments continued to mature post-infection. Maturation of IgG and IgA levels was similar in each compartment, however, mucosal antibody levels tended to be more variable. This SHIV assay elucidates IgG/IgA antibody kinetics in the plasma and vaginal mucosa and will be a valuable tool in vaccine and other biomedical intervention studies in the nonhuman primate model.
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Tavakoli A, Karbalaie Niya MH, Keshavarz M, Ghaffari H, Asoodeh A, Monavari SH, Keyvani H. Current diagnostic methods for HIV. Future Virol 2017. [DOI: 10.2217/fvl-2016-9999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Ahmad Tavakoli
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | | | - Mohsen Keshavarz
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | - Hadi Ghaffari
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | - Amir Asoodeh
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Khorasan, IR Iran
| | - Seyed Hamidreza Monavari
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | - Hossein Keyvani
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
- Gastrointestinal & Liver Diseases Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, IR Iran
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Identification of Acute HIV-1 Infection by Hologic Aptima HIV-1 RNA Qualitative Assay. J Clin Microbiol 2017; 55:2064-2073. [PMID: 28424253 PMCID: PMC5483908 DOI: 10.1128/jcm.00431-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 04/12/2017] [Indexed: 11/20/2022] Open
Abstract
The Hologic Aptima HIV-1 Qualitative RNA assay was used in a rigorous screening approach designed to identify individuals at the earliest stage of HIV-1 infection for enrollment into subsequent studies of cellular and viral events in early infection (RV 217/Early Capture HIV Cohort [ECHO] study). Volunteers at high risk for HIV-1 infection were recruited from study sites in Thailand, Tanzania, Uganda, and Kenya with high HIV-1 prevalence rates among the populations examined. Small-volume blood samples were collected by finger stick at twice-weekly intervals and tested with the Aptima assay. Participants with reactive Aptima test results were contacted immediately for entry into a more comprehensive follow-up schedule with frequent blood draws. Evaluation of the Aptima test prior to use in this study showed a detection sensitivity of 5.5 copies/ml (50%), with all major HIV-1 subtypes detected. A total of 54,306 specimens from 1,112 volunteers were examined during the initial study period (August 2009 to November 2010); 27 individuals were identified as converting from uninfected to infected status. A sporadic reactive Aptima signal was observed in HIV-1-infected individuals under antiretroviral therapy. Occasional false-reactive Aptima results in uninfected individuals, or nonreactive results in HIV-1-infected individuals not on therapy, were observed and used to calculate assay sensitivity and specificity. The sensitivity and specificity of the Aptima assay were 99.03% and 99.23%, respectively; positive and negative predictive values were 92.01% and 99.91%, respectively. Conversion from HIV-1-uninfected to -infected status was rapid, with no evidence of a prolonged period of intermittent low-level viremia.
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Tavakoli A, Karbalaie Niya MH, Keshavarz M, Ghaffari H, Asoodeh A, Monavari SH, Keyvani H. Current diagnostic methods for HIV. Future Virol 2017. [DOI: 10.2217/fvl-2016-0096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Detection of HIV infection is essential for diagnosis and monitoring of the infection. There are different types of diagnostic tools available that are based on detection of HIV-specific antibodies, viral antigen or nucleic acid. Sensitivities and specificities of assays utilized for HIV detection have improved. Newer HIV testing technologies such as third-generation enzyme immunoassay which detect HIV-specific IgG and IgM antibodies, fourth-generation enzyme immunoassay which detect both anti-HIV antibodies and HIV p24 antigen and nucleic acid based tests for HIV RNA have significantly decreased the window period. This review provides an overview of current technologies for the detection and monitoring of HIV infection and recent advances in the field of HIV diagnosis.
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Affiliation(s)
- Ahmad Tavakoli
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | | | - Mohsen Keshavarz
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | - Hadi Ghaffari
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | - Amir Asoodeh
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Khorasan, IR Iran
| | - Seyed Hamidreza Monavari
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | - Hossein Keyvani
- Department of Virology, Faculty of medicine, Iran University of Medical Sciences, Tehran, IR Iran
- Gastrointestinal & Liver Diseases Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, IR Iran
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