1
|
Eke AC, Gebreyohannes RD, Powell AM. Understanding clinical outcome measures reported in HIV pregnancy studies involving antiretroviral-naive and antiretroviral-experienced women. THE LANCET. INFECTIOUS DISEASES 2023; 23:e151-e159. [PMID: 36375478 PMCID: PMC10040432 DOI: 10.1016/s1473-3099(22)00687-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/02/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022]
Abstract
HIV infection is a clinically significant public health disease and contributes to increased risk of maternal and fetal morbidity and mortality. HIV pregnancy studies use outcome measures as metrics to show how people with HIV feel, function, or survive. These endpoints are crucial for tracking the evolution of HIV illness over time, assessing the effectiveness of antiretroviral therapy (ART), and comparing outcomes across studies. Although the need for ideal outcome measures is widely acknowledged, selecting acceptable outcome measures for these HIV pregnancy studies can be challenging. We discuss the many outcome measures that have been implemented over time to assess HIV in pregnancy studies, their benefits, and drawbacks. Finally, we offer suggestions for improving the reporting of outcome measures in HIV in pregnancy studies. Medical professionals can best care for pregnant women living with HIV receiving ART by having a thorough understanding of these outcome metrics.
Collapse
Affiliation(s)
- Ahizechukwu C Eke
- Division of Maternal Foetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Rahel D Gebreyohannes
- Department of Obstetrics and Gynaecology, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Anna M Powell
- Department of Gynaecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
2
|
Manavi K, Hodson J, Masuka S, Singo M, Dedicoat K, Osman H. Correlation between Cepheid GeneXpert and Abbott M2000 assays for HIV viral load measurements. Int J STD AIDS 2021; 32:444-448. [PMID: 33427080 DOI: 10.1177/0956462420975606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Measurement of HIV viral load (VL) is the best indicator of success of antiretroviral therapy. We investigated the correlation between results by the Cepheid GeneXpert and a standard of care VL assay (Abbott M2000). This was a prospective study of people living with HIV who attended the department for routine VL measurement with the Abbott M2000. Consenting patients agreed to provide one extra blood sample for VL measurement with the Cepheid GeneXpert assay. One hundred patients consented to participate in the study. There were 18 patients with VL ≥ 40 copies/mL and 75 patients with VL < 40 copies on both assays. The two assays had 93% agreement, with a kappa of 0.79 (p < 0.001). Treating VL as a continuous variable found measurements to be significantly higher on the Cepheid GeneXpert assay than the Abbott (p = 0.002). Analysis of samples with VL ≥ 40 copies/mL on either assay (n = 25) found the mean difference between the two assays to be 0.31 log10 copies/mL (95% limits of agreement: -0.63, 1.25). Whilst the measurements on the two assays are relatively highly correlated, there is a clear bias, with the Cepheid GeneXpert tending to give higher VL values.
Collapse
Affiliation(s)
- Kaveh Manavi
- Department of HIV, 1732University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - James Hodson
- Medical Statistician, 1732University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sindiso Masuka
- Department of HIV, 1732University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mebie Singo
- Department of HIV, 1732University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Katie Dedicoat
- Department of Microbiology, 1732University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Husam Osman
- Department of Microbiology, 1732University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
3
|
Maree L, Krügel M, Reinhardt B, Glass AJ. Evaluation of the Alinity m HIV-1 assay for the quantification of HIV-1 RNA plasma viral load in a high-throughput molecular laboratory in South Africa. J Clin Virol 2020; 132:104644. [DOI: 10.1016/j.jcv.2020.104644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022]
|
4
|
Kulkarni S, Jadhav S, Khopkar P, Sane S, Londhe R, Chimanpure V, Dhilpe V, Ghate M, Yelagate R, Panchal N, Rahane G, Kadam D, Gaikwad N, Rewari B, Gangakhedkar R. GeneXpert HIV-1 quant assay, a new tool for scale up of viral load monitoring in the success of ART programme in India. BMC Infect Dis 2017; 17:506. [PMID: 28732472 PMCID: PMC5521114 DOI: 10.1186/s12879-017-2604-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 07/17/2017] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Recent WHO guidelines identify virologic monitoring for diagnosing and confirming ART failure. In view of this, validation and scale up of point of care viral load technologies is essential in resource limited settings. METHODS A systematic validation of the GeneXpert® HIV-1 Quant assay (a point-of-care technology) in view of scaling up HIV-1 viral load in India to monitor the success of national ART programme was carried out. Two hundred nineteen plasma specimens falling in nine viral load ranges (<40 to >5 L copies/ml) were tested by the Abbott m2000rt Real Time and GeneXpert HIV-1 Quant assays. Additionally, 20 seronegative; 16 stored specimens and 10 spiked controls were also tested. Statistical analysis was done using Stata/IC and sensitivity, specificity, PPV, NPV and %misclassification rates were calculated as per DHSs/AISs, WHO, NACO cut-offs for virological failure. RESULTS The GeneXpert assay compared well with the Abbott assay with a higher sensitivity (97%), specificity (97-100%) and concordance (91.32%). The correlation between two assays (r = 0.886) was statistically significant (p < 0.01), the linear regression showed a moderate fit (R2 = 0.784) and differences were within limits of agreement. Reproducibility showed an average variation of 4.15 and 3.52% while Lower limit of detection (LLD) and Upper limit of detection (ULD) were 42 and 1,740,000 copies/ml respectively. The misclassification rates for three viral load cut offs were not statistically different (p = 0.736). All seronegative samples were negative and viral loads of the stored samples showed a good fit (R2 = 0.896 to 0.982). CONCLUSION The viral load results of GeneXpert HIV-1 Quant assay compared well with Abbott HIV-1 m2000 Real Time PCR; suggesting its use as a Point of care assay for viral load estimation in resource limited settings. Its ease of performance and rapidity will aid in timely diagnosis of ART failures, integrated HIV-TB management and will facilitate the UNAIDS 90-90-90 target.
Collapse
Affiliation(s)
- Smita Kulkarni
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India.
| | - Sushama Jadhav
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Priyanka Khopkar
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Suvarna Sane
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Rajkumar Londhe
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Vaishali Chimanpure
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Veronica Dhilpe
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Manisha Ghate
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Rajendra Yelagate
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Narayan Panchal
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Girish Rahane
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| | - Dilip Kadam
- Byramjee Jeejeebhoy Medical College (BJMC), Sassoon General Hospital, Jai Prakash Narayan Road, Near Pune Railway Station, Pune, Maharashtra, 411001, India
| | - Nitin Gaikwad
- Yashwantrao Chavan Memorial Hospital (YCM), No.476/2692, Sant Tukaram Nagar, Pimpri, Pimpri-Chinchwad, Pune, Maharashtra, 411018, India
| | - Bharat Rewari
- World Health Organization (WHO) Country office for India, World Health House, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi, Delhi, 110002, India
| | - Raman Gangakhedkar
- Department of Virology, National AIDS Research Institute, Plot No 73, G-block, M I D C, Bhosari, Pune, Maharashtra, 411026, India
| |
Collapse
|
5
|
Avidor B, Matus N, Girshengorn S, Achsanov S, Gielman S, Zeldis I, Schweitzer I, Adler A, Turner D. Comparison between Roche and Xpert in HIV-1 RNA quantitation: A high concordance between the two techniques except for a CRF02_AG subtype variant with high viral load titters detected by Roche but undetected by Xpert. J Clin Virol 2017; 93:15-19. [PMID: 28564629 DOI: 10.1016/j.jcv.2017.05.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/14/2017] [Accepted: 05/14/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND HIV-1 viral load (VL) testing is important to predict viral progression and to monitor the response to antiretroviral therapy. New HIV-1 VL tests are continuously introduced to the market. Their performance is usually compared to Abbott and/or Roche HIV-1 VL assays, as reference. The Xpert HIV-1 VL test was recently introduced, but its performance compared to Roche has not been sufficiently studied. OBJECTIVES To compare the Xpert assay with Roche and to assess its use in the HIV clinical laboratory. STUDY DESIGN A total of 383 plasma samples of HIV-1 infected patients previously tested by Roche, were retrospectively tested by Xpert to determine concordance between the two assays. Samples included a diversity of HIV-1 subtypes and a wide range of VLs. RESULTS There was a high concordance between the two assays, except for a CRF02_AG subtype variant with high VL titters, that was detected by Roche but undetected by Xpert. The 5' long terminal repeat gene region of this virus, targeted by the Xpert assay, was amplified and sequenced. A 25 nucleotide insert was identified, but was unmatched to any known sequences of HIV-1. This particular insert, however could not explain the false-negativity by the Xpert assay. CONCLUSIONS This study underlines the challenge to routine VL testing due to the high genetic diversity of HIV-1. Clinicians should, therefore be advised that a negative VL in cases where the clinical picture does not match the laboratory report, might in fact be, a false-negative result of the VL assay.
Collapse
Affiliation(s)
- Boaz Avidor
- Laboratory for Viruses and Molecular Biology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Crusaid Kobler AIDS Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Natalia Matus
- Laboratory for Viruses and Molecular Biology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Crusaid Kobler AIDS Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shirley Girshengorn
- Laboratory for Viruses and Molecular Biology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Crusaid Kobler AIDS Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Svetlana Achsanov
- Laboratory for Viruses and Molecular Biology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Crusaid Kobler AIDS Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Simona Gielman
- Laboratory for Viruses and Molecular Biology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Crusaid Kobler AIDS Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Irene Zeldis
- Laboratory for Viruses and Molecular Biology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Crusaid Kobler AIDS Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Inbal Schweitzer
- Laboratory for Viruses and Molecular Biology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Crusaid Kobler AIDS Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amos Adler
- Laboratory for Microbiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan Turner
- Crusaid Kobler AIDS Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
6
|
Evaluation of the RealTime HIV-1, Xpert HIV-1, and Aptima HIV-1 Quant Dx Assays in Comparison to the NucliSens EasyQ HIV-1 v2.0 Assay for Quantification of HIV-1 Viral Load. J Clin Microbiol 2015; 53:3458-65. [PMID: 26292298 DOI: 10.1128/jcm.01806-15] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/10/2015] [Indexed: 01/06/2023] Open
Abstract
HIV-1 RNA monitoring, both before and during antiretroviral therapy, is an integral part of HIV management worldwide. Measurements of HIV-1 viral loads are expected to assess the copy numbers of all common HIV-1 subtypes accurately and to be equally sensitive at different viral loads. In this study, we compared for the first time the performance of the NucliSens v2.0, RealTime HIV-1, Aptima HIV-1 Quant Dx, and Xpert HIV-1 viral load assays. Plasma samples (n = 404) were selected on the basis of their NucliSens v2.0 viral load results and HIV-1 subtypes. Concordance, linear regression, and Bland-Altman plots were assessed, and mixed-model analysis was utilized to compare the analytical performance of the assays for different HIV-1 subtypes and for low and high HIV-1 copy numbers. Overall, high concordance (>83.89%), high correlation values (Pearson r values of >0.89), and good agreement were observed among all assays, although the Xpert and Aptima assays, which provided the most similar outputs (estimated mean viral loads of 2.67 log copies/ml [95% confidence interval [CI], 2.50 to 2.84 log copies/ml] and 2.68 log copies/ml [95% CI, 2.49 to 2.86 log copies/ml], respectively), correlated best with the RealTime assay (89.8% concordance, with Pearson r values of 0.97 to 0.98). These three assays exhibited greater precision than the NucliSens v2.0 assay. All assays were equally sensitive for subtype B and AG/G samples and for samples with viral loads of 1.60 to 3.00 log copies/ml. The NucliSens v2.0 assay underestimated A1 samples and those with viral loads of >3.00 log copies/ml. The RealTime assay tended to underquantify subtype C (compared to the Xpert and Aptima assays) and subtype A1 samples. The Xpert and Aptima assays were equally efficient for detection of all subtypes and viral loads, which renders these new assays most suitable for clinical HIV laboratories.
Collapse
|
7
|
Pantazis N, Porter K, Costagliola D, De Luca A, Ghosn J, Guiguet M, Johnson AM, Kelleher AD, Morrison C, Thiebaut R, Wittkop L, Touloumi G. Temporal trends in prognostic markers of HIV-1 virulence and transmissibility: an observational cohort study. Lancet HIV 2014; 1:e119-26. [PMID: 26424120 DOI: 10.1016/s2352-3018(14)00002-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/28/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Measures of CD4 T-cell count and HIV-1 plasma viral load before antiretroviral therapy are proxies for virulence. Whether these proxies are changing over time has implications for prevention and treatment. The aim of this study was to investigate those trends. METHODS Data were derived from the Concerted Action on SeroConversion to AIDS and Death in Europe (CASCADE) collaboration of mainly European seroconverter cohorts. Longitudinal CD4 cell counts and plasma viral load measurements before the initiation of antiretroviral therapy or AIDS onset were analysed by use of linear or fractional polynomials mixed models adjusting for all available potential confounders. Calendar time effects were modelled through natural cubic splines. FINDINGS 15 875 individuals seroconverting from 1979 to 2008 fulfilled the inclusion criteria; 3215 (20·3%) were women; median follow-up was 31 months (IQR 14-62); dropout before starting antiretroviral therapy or AIDS onset was 8·1%. Estimated CD4 counts at seroconversion for a typical individual declined from about 770 cells per μL (95% CI 750-800) in the early 1980s to a plateau of about 570 cells per μL (555-585) after 2002. CD4 cell rate of loss increased up to 2002. Estimated set-point plasma viral loads increased from 4·05 log10 copies per mL (95% CI 3·98-4·12) in 1980 to 4·50 log10 copies per mL (4·45-4·54) in 2002 with a tendency of returning to lower loads thereafter. Results were similar when we restricted analyses to various subsets, including adjusting for plasma viral load assay, censored follow-up at 3 years, or used variations of the main statistical approach. INTERPRETATION Our results provide strong indications of increased HIV-1 virulence and transmissibility during the course of the epidemic and a potential plateau effect after about 2002. FUNDING European Union Seventh Framework Programme.
Collapse
Affiliation(s)
| | | | - Dominique Costagliola
- INSERM, U1136, Paris, France; UPMC Université Paris 06, UMR S1136, Paris, France; AP-HP, Groupe hospitalier Pitié-Salpétrière, Service des maladies infectieuses et tropicales, Paris, France
| | - Andrea De Luca
- Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy; Unit of Infectious Diseases, Siena University Hospital, Siena, Italy
| | - Jade Ghosn
- AP-HP, Hôpital Bicêtre, Service de médecine interne, Le Kremlin-Bicêtre, Paris, France; Faculté de Médecine site Necker, Université Paris Descartes, EA 3620, Paris, France
| | - Marguerite Guiguet
- INSERM, U1136, Paris, France; UPMC Université Paris 06, UMR S1136, Paris, France
| | - Anne M Johnson
- Research Department of Infection and Population Health, University College London, London, UK
| | | | | | - Rodolphe Thiebaut
- INSERM U897 Centre of Epidemiology and Biostatistics, ISPED Bordeaux School of Public Health, University Bordeaux Segalen, Bordeaux, France
| | - Linda Wittkop
- INSERM U897 Centre of Epidemiology and Biostatistics, ISPED Bordeaux School of Public Health, University Bordeaux Segalen, Bordeaux, France
| | | | | |
Collapse
|
8
|
Amendola A, Marsella P, Bloisi M, Forbici F, Angeletti C, Capobianchi MR. Ability of two commercially available assays (Abbott RealTime HIV-1 and Roche Cobas AmpliPrep/Cobas TaqMan HIV-1 Version 2.0) to quantify low HIV-1 RNA Levels (<1,000 copies/milliliter): comparison with clinical samples and NIBSC working reagent for nucleic acid testing assays. J Clin Microbiol 2014; 52:2019-26. [PMID: 24671791 PMCID: PMC4042785 DOI: 10.1128/jcm.00288-14] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/21/2014] [Indexed: 11/20/2022] Open
Abstract
Concordance between molecular assays may be suboptimal at low HIV-1 viremia levels (<1,000 copies/ml); therefore, it may be difficult to define and compare virologic endpoints for successful and failed therapy. We compared two commercial assays (the Abbott RealTime HIV-1 and the Roche Cobas AmpliPrep/TaqMan HIV-1 version 2.0) for their ability to detect and quantify low viral loads. A comparison was performed using 167 residual clinical samples (with values ranging from "not detected" to 1,000 copies/ml, as measured by the Abbott assay) and the National Institute and Biological Standards and Control (NIBSC) HIV-1 RNA working reagent 1 for nucleic acid amplification techniques (NAT) assays (serially diluted to a range from 1 to 1,000 copies/ml). Quantitative results were compared using Lin's concordance correlation coefficient and a Bland-Altman plot. Concordance with the qualitative results was measured by Cohen's kappa statistic. With clinical samples, the degree of interassay concordance of the qualitative results at a 40-copies/ml HIV-1 RNA threshold was substantial (κ = 0.762); the correlation among the quantified samples was suboptimal (concordance correlation coefficient, 0.728; P < 0.0001); the mean difference of the values between the Roche and Abbott assays was 0.193 log10 copies/ml. Using the HIV-1 RNA working reagent 1 for NAT assays, the results provided by the Roche assay were, on average, 3 times higher than expected, while the Abbott assay showed high accuracy. The Roche assay was highly sensitive, being able to detect a level as low as 3.5 copies/ml HIV-1 RNA with 95% probability. The performance characteristics of each molecular assay should be taken into account when HIV-1 RNA threshold values for "virologic suppression," "virologic failure," "persistent low viral loads," etc., are defined and indicated in the support of clinical decisions.
Collapse
Affiliation(s)
| | - Patrizia Marsella
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Maria Bloisi
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Federica Forbici
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Claudio Angeletti
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | | |
Collapse
|
9
|
Briggs R, Templeton K, Fernando I. Comparing HIV viral load assays and frequency of low level virological rebound in clinical practice. Int J STD AIDS 2014; 25:1029-34. [DOI: 10.1177/0956462414528313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research suggests that some low-level virological rebound results occurring for no obvious clinical cause, in patients stable on antiretroviral therapy (ART), may be a consequence of the viral load assay used. We compared the relative frequency of clinically unexplained low-level virological rebound results when using the Roche HIV Taqman version-1 (CTM v1), the Roche HIV Taqman version-2 (CTM v2) and the Abbott RealTime (Abbott RT) assays in clinical practice. In all, 247 patients from our centre who had their viral loads measured by the three different assays over a period of 3 consecutive years (each assay used for a period of 1 year each) were included in the study. Low-level virological rebound was defined as <1000 copies/ml. Over similar time periods, there was significant discrepancy between the three assays when considering the proportion of clinically unexplained low-level virological rebound results in patients stable on ART: the CTM v2 assay produced the highest percentage (93%), CTM v1 much lower (65%) and Abbott RT even less (35%). There is further research required regarding what, if any, implications this has for patients who experience clinically unexplained low-level virological rebound on the more sensitive assays.
Collapse
Affiliation(s)
- R Briggs
- University of Edinburgh Medical School, Edinburgh, UK
| | - K Templeton
- Microbiology and Virology Laboratories, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - I Fernando
- Chalmers Sexual Health Centre, NHS Lothian, Edinburgh, UK
| |
Collapse
|
10
|
Swenson LC, Cobb B, Geretti AM, Harrigan PR, Poljak M, Seguin-Devaux C, Verhofstede C, Wirden M, Amendola A, Boni J, Bourlet T, Huder JB, Karasi JC, Zidovec Lepej S, Lunar MM, Mukabayire O, Schuurman R, Tomažič J, Van Laethem K, Vandekerckhove L, Wensing AMJ. Comparative performances of HIV-1 RNA load assays at low viral load levels: results of an international collaboration. J Clin Microbiol 2014; 52:517-23. [PMID: 24478482 PMCID: PMC3911321 DOI: 10.1128/jcm.02461-13] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 11/26/2013] [Indexed: 11/20/2022] Open
Abstract
Low-level viremia during antiretroviral therapy and its accurate measurement are increasingly relevant. Here, we present an international collaboration of 4,221 paired blood plasma viral load (pVL) results from four commercial assays, emphasizing the data with low pVL. The assays compared were the Abbott RealTime assay, the Roche Amplicor assay, and the Roche TaqMan version 1 and version 2 assays. The correlation between the assays was 0.90 to 0.97. However, at a low pVL, the correlation fell to 0.45 to 0.85. The observed interassay concordance was higher when detectability was defined as 200 copies/ml than when it was defined as 50 copies/ml. A pVL of ∼100 to 125 copies/ml by the TaqMan version 1 and version 2 assays corresponded best to a 50-copies/ml threshold with the Amplicor assay. Correlation and concordance between the viral load assays were lower at a low pVL. Clear guidelines are needed on the clinical significance of low-level viremia.
Collapse
Affiliation(s)
- Luke C. Swenson
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Bryan Cobb
- Roche Molecular Systems, Pleasanton, California, USA
| | - Anna Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, United Kingdom
| | | | - Mario Poljak
- University of Ljubljana, Institute of Microbiology and Immunology, Ljubljana, Slovenia
| | | | | | - Marc Wirden
- AP-HP, Pitié-Salpêtrière Hospital, INSERM U 943, and Pierre et Marie Curie University Paris, Paris, France
| | - Alessandra Amendola
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Jurg Boni
- Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | - Thomas Bourlet
- Laboratory of Virology, CHU de Saint-Etienne, Saint-Etienne, France
| | - Jon B. Huder
- Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | | | | | - Maja M. Lunar
- University of Ljubljana, Institute of Microbiology and Immunology, Ljubljana, Slovenia
| | | | - Rob Schuurman
- University Medical Center Utrecht, Utrecht, Netherlands
| | - Janez Tomažič
- University of Ljubljana, Institute of Microbiology and Immunology, Ljubljana, Slovenia
| | - Kristel Van Laethem
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | | | | |
Collapse
|
11
|
Murray JM, Zaunders JJ, Koelsch KK, Natarajan V, Badralmaa Y, McBride K, Carrera A, Cooper DA, Emery S, Kelleher AD. Short communication: HIV blips while on antiretroviral therapy can indicate consistently detectable viral levels due to assay underreporting. AIDS Res Hum Retroviruses 2013; 29:1621-5. [PMID: 23844947 DOI: 10.1089/aid.2013.0132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Viral blips, where HIV RNA plasma viral load (pVL) intermittently increases above the lower limit of assay detection, are a cause for concern. We investigated a number of hypotheses for their cause. We assessed HIV RNA, and total and episomal HIV DNA from 16 individuals commencing antiretroviral therapy (ART) consisting of raltegravir and tenofovir/emtricitabine for 3 years, using two assays: a single-copy assay [SCA; lower limit of quantification (LLOQ), <1 copy/ml] and the Amplicor assay (LLOQ of 50 copies/ml). Two individuals exhibited viral blips. From week 20 onward, the period where ART had achieved its final suppressive levels, pVL ranged from <1 to 330 copies/ml, except for one individual at the final time. Both assays were 98% consistent (108/110) in assessing pVL <50 copies/ml, but the Amplicor assay registered 56% of samples (19/34) as below the LLOQ that were in the 50 to 1000 copy/ml range as quantified by SCA. pVL changes between successive time points did not correlate with changes in cellular infection as measured through either total or episomal HIV DNA. Changes in pVL were correlated (negatively) with changes in total CD4(+) T cell numbers (p=0.003), naive (CD45RO(-)CD62L(+)CD4(+)), natural regulatory (CD45RO(-)CD25(+)CD127(-)CD4(+)), activated effector (CD45RO(+)CD38(++)CCR5(+)CD8(+)), but not activated (CD38(+)HLA-DR(+)) CD4(+) T cells. Patients receiving stable, seemingly suppressive ART can have pVL near the 50 copy LLOQ at multiple time points. The high Amplicor assay error rate around this level implies that viral blips underrepresent pVL being more consistently above the LLOQ. Activation of latently infected cells is less likely to contribute to this phenomenon.
Collapse
Affiliation(s)
- John M. Murray
- School of Mathematics and Statistics, University of New South Wales, Sydney, NSW, Australia
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - John J. Zaunders
- St Vincent's Hospital, Sydney, Centre for Applied Medical Research, Darlinghurst, NSW, Australia
| | - Kersten K. Koelsch
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
- St Vincent's Hospital, Sydney, Centre for Applied Medical Research, Darlinghurst, NSW, Australia
| | | | | | - Kristin McBride
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Alexander Carrera
- NSW HIV Reference Laboratory, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - David A. Cooper
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
- St Vincent's Hospital, Sydney, Centre for Applied Medical Research, Darlinghurst, NSW, Australia
| | - Sean Emery
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Anthony D. Kelleher
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
- St Vincent's Hospital, Sydney, Centre for Applied Medical Research, Darlinghurst, NSW, Australia
| |
Collapse
|
12
|
Garcia-Diaz A, Labbett W, Clewley GS, Guerrero-Ramos A, Geretti AM. Comparative evaluation of the Artus HIV-1 QS-RGQ assay and the Abbott RealTime HIV-1 assay for the quantification of HIV-1 RNA in plasma. J Clin Virol 2013; 57:66-9. [DOI: 10.1016/j.jcv.2013.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 12/21/2012] [Accepted: 01/03/2013] [Indexed: 11/28/2022]
|
13
|
Sauné K, Delaugerre C, Raymond S, Nicot F, Boineau J, Pasquier C, Izopet J. Analytical sensitivity of three real-time PCR assays for measuring subtype B HIV-1 RNA. J Clin Virol 2013; 57:80-3. [DOI: 10.1016/j.jcv.2012.12.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 12/19/2012] [Accepted: 12/20/2012] [Indexed: 10/27/2022]
|
14
|
Viljoen CD, Thompson GG, Sreenivasan S. Stability of ultramer as copy number standards in real-time PCR. Gene 2013; 516:143-5. [DOI: 10.1016/j.gene.2012.12.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 12/02/2012] [Indexed: 11/17/2022]
|
15
|
Novel clinical trial designs and HIV-1 RNA assessments with end-point and real-time PCR tests. AIDS 2012; 26:1453-4. [PMID: 22767348 DOI: 10.1097/qad.0b013e3283550dc8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Comparison of HIV-1 viral load assay performance in immunological stable patients with low or undetectable viremia. Med Microbiol Immunol 2012; 202:67-75. [PMID: 22699843 DOI: 10.1007/s00430-012-0249-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 05/26/2012] [Indexed: 10/27/2022]
Abstract
The goal of antiretroviral therapy is reduction in morbidity and mortality via suppression of human immunodeficiency virus (HIV) viral load (VL) to undetectable levels. VL assay sensitivity has improved over time, but the reproducibility and clinical importance of VL results marginally higher than the limit of detection (LoD) are uncertain. We assessed the reproducibility and concordance of low VL results obtained with the Roche Cobas AmpliPrep/Cobas TaqMan HIV-1 version 2.0 (CAP-CTM) and the Abbott RealTime (m2000) HIV-1 assays, using longitudinal specimens from HIV-1-infected patients with low VL (<300 copies/ml) and stable CD4+ cell counts. Based on replicate testing of 3 specimens, coefficients of variation for log-transformed VL results were 5-8 % for m2000 and 9-10 % for CAP-CTM. The concordance between assays in specimens from patients with previously undetectable, detectable but not quantifiable VL, or variable (undetectable/detectable but not quantifiable VL) results over time was 90, 56, and 56 %, respectively. Correlation between results for specimens with quantifiable VL (initially 40-300 copies/ml) was moderate (R (2) = 0.48) with significantly higher results for CAP-CTM and a mean difference (CAP-CTM minus m2000) of 0.10 log(10) copies/ml. T-cell activation (CD8+/CD38+ percentage) in patients with low VL was initially higher than in patients with undetectable VL, and then decreased to equivalent levels over time. These results indicate that residual viremia at levels slightly above the LoD have no negative effect on T-cell activation.
Collapse
|
17
|
Ruelle J, Debaisieux L, Vancutsem E, De Bel A, Delforge ML, Piérard D, Goubau P. HIV-1 low-level viraemia assessed with 3 commercial real-time PCR assays show high variability. BMC Infect Dis 2012; 12:100. [PMID: 22530816 PMCID: PMC3445837 DOI: 10.1186/1471-2334-12-100] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 04/24/2012] [Indexed: 01/29/2023] Open
Abstract
Background Current real-time PCR-based HIV-1 viral load (VL) assays allow the detection of residual viraemia in antiretroviral-treated patients. The clinical outcome of HIV1 patients experiencing low-level replication (<50 cop/mL) in comparison with fully suppressed patients is currently debated. We analysed variability of 3 VL assays <50 cop/mL, and evaluated the reproducibility of viral blips <100 cop/mL. Methods Three commercial VL assays were tested: Versant HIV-1 RNA 1.0 kPCR (Siemens), Abbott Realtime HIV-1, and Cobas Ampliprep/Cobas Taqman HIV-1 v2.0 (Roche). Ten replicates of a reference sample at 4 low target dilutions were tested to evaluate assay variability. Prospective collection of 181 clinical samples with detectable VL <50 cop/mL was used to evaluate intra-and inter-assay variability by triplicate testing. Samples from 26 patients experiencing a viral blip were retested. Results All assays showed substantial variability at low VL level: the coefficient of variation at 100, 50, 25 and 12 cop/mL ranged respectively from 32 to 44%, 35 to 68%, 41 to 83% and 33 to 77%. In the intra-assay evaluation of repeatability, 52.5 to 57.5% of detectable VL <50 cop/mL tested in triplicate showed at least one fully undetected result. Variability was similar in the inter-assay arm. The VL blips could only be reproduced in 19% of cases. Conclusions The most recent versions of widespread commercial VL assays showed substantial variability at low levels and residual viraemia could not be consistently reproduced. Patient outcome studies comparing residual VL to full suppression are therefore biased when using commercial assays.
Collapse
Affiliation(s)
- Jean Ruelle
- UCLouvain, AIDS Reference Laboratory, Avenue Hippocrate 54 - B1.54.05, 1200 Brussels, Belgium.
| | | | | | | | | | | | | |
Collapse
|
18
|
Cobb BR, Vaks JE, Do T, Vilchez RA. Evolution in the sensitivity of quantitative HIV-1 viral load tests. J Clin Virol 2011; 52 Suppl 1:S77-82. [DOI: 10.1016/j.jcv.2011.09.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
19
|
Taiwo B, Zheng L, Gallien S, Matining RM, Kuritzkes DR, Wilson CC, Berzins BI, Acosta EP, Bastow B, Kim PS, Eron JJ. Efficacy of a nucleoside-sparing regimen of darunavir/ritonavir plus raltegravir in treatment-naive HIV-1-infected patients (ACTG A5262). AIDS 2011; 25:2113-22. [PMID: 21857490 PMCID: PMC3515052 DOI: 10.1097/qad.0b013e32834bbaa9] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To explore darunavir/ritonavir (DRV/r) plus raltegravir (RAL) combination therapy in antiretroviral-naive patients. DESIGN Phase IIb, single-arm, open-label, multicenter study. METHODS One hundred and twelve antiretroviral-naive, HIV-1-infected patients received DRV/r 800/100 mg once daily and RAL 400 mg twice daily. Primary endpoint was virologic failure by week 24. Virologic failure was defined as confirmed viral load of 1000 copies/ml or more at week 12, or an increase of more than 0.5 log(10) copies/ml in viral load from week 4 to 12, or a confirmed viral load of more than 50 copies/ml at or after week 24. Protease and integrase genes were sequenced in patients experiencing virologic failure. RESULTS Virologic failure rate was 16% [95% confidence interval (CI) 10-24] by week 24 and 26% (95% CI 19-36) by week 48 in an intent-to-treat analysis. Viral load at virologic failure was 51-200 copies/ml in 17/28 failures. Adjusting for age and sex, virologic failure was associated with baseline viral load of more than 100,000 copies/ml [hazard ratio 3.76, 95% CI (1.52-9.31), P = 0.004] and lower CD4 cell count [0.77 per 100 cells/μl increase (95% CI 0.61-0.98), P = 0.037]. When trough RAL concentrations were included as a time-varying covariate in the analysis, virologic failure remained associated with baseline viral load more than 100,000 copies/ml [hazard ratio = 4.67 (95% CI 1.93-11.25), P < 0.001], whereas RAL level below detection limit in plasma at one or more previous visits was associated with increased hazard [hazard ratio = 3.42 (95% CI 1.41-8.26), P = 0.006]. All five participants with integrase mutations during virologic failure had baseline viral load more than 100,000 copies/ml. CONCLUSION DRV/r plus RAL was effective and well tolerated in most patients, but virologic failure and integrase resistance were common, particularly in patients with baseline viral load more than 100,000 copies/ml.
Collapse
Affiliation(s)
- Babafemi Taiwo
- Division of Infectious Diseases, Northwestern University, Chicago, Illinois 60611, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Karasi J, Dziezuk F, Quennery L, Förster S, Reischl U, Colucci G, Schoener D, Seguin-Devaux C, Schmit J. High correlation between the Roche COBAS® AmpliPrep/COBAS® TaqMan® HIV-1, v2.0 and the Abbott m2000 RealTime HIV-1 assays for quantification of viral load in HIV-1 B and non-B subtypes. J Clin Virol 2011; 52:181-6. [DOI: 10.1016/j.jcv.2011.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 06/01/2011] [Accepted: 07/05/2011] [Indexed: 10/17/2022]
|
21
|
Sandres-Sauné K, Raymond S, Nicot F, Boineau J, Pasquier C, Izopet J. Evaluation of the QIAsymphony™ SP and Artus™ RealTime extraction-quantification systems for measuring HIV-1 virus load. J Clin Virol 2011; 52:349-52. [PMID: 21945406 DOI: 10.1016/j.jcv.2011.08.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 08/27/2011] [Accepted: 08/29/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Automated HIV-1 RNA extraction and its quantification by real-time PCR assays provide improved sample processing and better analytical performances. The new Artus HIV-1 RealTime assay can be performed after automated extraction with the Qiagen Qiasymphony robot. OBJECTIVES AND STUDY DESIGN To evaluate the sensitivity, reproducibility, linearity, ability to detect HIV-1 subtypes of the Qiagen Qiasymphony and RealTime Artus HIV-1 assay system and to compare with the Roche Cobas Ampliprep Cobas TaqMan assay, vs 2.0 (CAP/CTM; Roche Molecular Systems). RESULTS The detection limit calculated by probit analysis was 65 c/ml using dilutions of a NIBSC. Assays of serially diluted clinical samples gave very good inter-assay and intra-assay reproducibilities (<10% CV) and linearity (2.2-6.5 log copies/ml). The results Artus™ HIV-1 and CAP/CTM assays provided very similar results: average difference=0.11 log copies/ml. The Artus™ titers for 18 (22%) of the 114 HIV-1 group M samples tested differed by over 0.5 log copies/ml from the CAP/CTM titers. The Artus™ values were lower than the CAP/CTM values in 83% of cases. Discrepant results were not associated with particular subtypes. CONCLUSION The Artus™ HIV-1 assay reliably quantified the HIV RNA in clinical specimens. Analytical performances were good and it integrated well with the Qiasymphony automated RNA extraction procedure. It appears to be appropriate for monitoring therapy and the routine management of HIV-1 infections.
Collapse
Affiliation(s)
- K Sandres-Sauné
- INSERM U1043, Centre de Physiopathologie de Toulouse Purpan, Toulouse F-31300, France.
| | | | | | | | | | | |
Collapse
|