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Huang Y, Liu H, Dai S, Lan X, Liu S, Ren X, Huang C, Li X, Hong G. Evaluation of a two-test strategy for HIV screening in a low-prevalence setting and the indications for optimizing clinical management. Heliyon 2023; 9:e19400. [PMID: 37681153 PMCID: PMC10481286 DOI: 10.1016/j.heliyon.2023.e19400] [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: 10/19/2022] [Revised: 06/06/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
Objectives To evaluate a two-test strategy for HIV screening in the low-prevalence population and to assess the feasibility of utilizing the optimal signal-to-cutoff (S/CO) threshold on the chemiluminescence immunoassay(CMIA) and an additional rapid test on the gold immune-chromatography assay (GICA) for screening positive patients and optimization of clinical management. Methods We conducted a retrospective study of samples analyzed by the fourth-generation Architect HIV Ag/Ab combo assay (CMIA) in a large medical center between June 2017 and August 2020. Reactive samples underwent a second screening test using the rapid test GICA, followed by Western blot (WB) as the confirmatory test. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal S/CO. We calculated sensitivity, specificity, and predictive value based on our population. The performance of the single-test strategy (CMIA) was compared with that of the two-test strategy (CMIA and GICA). Logistic regression was used to analyze the factors of clinical characteristics leading to false positive results. Results A total of 220558 samples were screened by CMIA, and 429 patients met the inclusion criteria. Of these, CMIA produced 199 false-positive results with a median S/CO of 1.93(IQR1.45-3.68) and 230 positive results with a median S/CO of 455.1 (IQR169.3-709.7). The optimal S/CO of the single-test strategy was 8.82, which achieved a sensitivity of 100% and a positive predictive value (PPV) of 90.9%. The two-test strategy (CMIA and GICA) provided a sensitivity of 100% and a PPV of 98.7%, which best correlated with the confirmatory test WB. The combination of S/CO 8.82 on the CMIA assay and additional test results of GICA can be defined as four types used to interpret HIV serostatus. The false positive rate (FPR) was high in the female, the age≤18 group, the pre-operative patients, and the patients from the clinical departments of Pediatrics, Gynecology and Obstetrics, and Oncology, etc. Conclusions The false positive rate is high in the low-prevalence setting by using CMIA. The two-test strategy (CMIA and GICA) is recommended for HIV screening in hospitals. Hopefully, the clinicians will be able to interpret HIV serostatus and facilitate clinical decision-making while waiting for the confirmatory results.
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Affiliation(s)
- Yu Huang
- Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Genetic Testing, Xiamen, China
| | - Haiyue Liu
- Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Genetic Testing, Xiamen, China
| | - Shuhui Dai
- Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xiaoying Lan
- Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Shuojie Liu
- Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Genetic Testing, Xiamen, China
| | - Xiaoying Ren
- Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Chaoyang Huang
- Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Genetic Testing, Xiamen, China
| | - Xun Li
- Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Genetic Testing, Xiamen, China
| | - Guolin Hong
- Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Genetic Testing, Xiamen, China
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Yang M, Yang W, Shi W, Tao C. Clinical Application Evaluation of Elecsys® HIV Duo Assay in Southwest China. Front Cell Infect Microbiol 2022; 12:877643. [PMID: 35663466 PMCID: PMC9157638 DOI: 10.3389/fcimb.2022.877643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/19/2022] [Indexed: 12/02/2022] Open
Abstract
Background HIV/AIDS continues to be a serious health concern of morbidity and mortality globally, and novel HIV testing is still an important component of diagnosing HIV earlier and reducing the spread of HIV. The Elecsys® HIV Duo assay is a 4th generation assay that can detect both HIV-1 p24 antigen (Ag) and HIV-1/2 antibody (Ab) in parallel and show the subresults for the Ab and Ab units. Objectives To evaluate the clinical performance of the Elecsys® HIV Duo assay on the new cobas E 801 analyzer using a large number of clinical samples from a population in southwest China. Methods We collected testing results and information from all patients in a large general hospital. All eligible clinical specimens were first analyzed using the Elecsys® HIV Duo assay. The test results are given either as reactive or nonreactive as well as in the form of a cutoff index (COI). All initially reactive specimens were retested in duplicate with a 3rd-generation kit. Supplementary tests were divided into Ab confirmation tests and HIV-1 nucleic acid tests. GraphPad Prism and Python were used for plotting, and SPSS 21.0 software was used for statistical analysis. Results A total of 186391 specimens were received, and 436 patients were confirmed to be positive for HIV. Among the 86 cases with contact history available, there were more males than females, and heterosexual transmission was the most common route of HIV infection. The Elecsys® HIV Duo assay displayed 99.94%, 99.93% and 99.98% specificity for inpatient, outpatient and physical examination patients, respectively. The median COI ratios of the false-positive group were significantly lower than those of the true-positive group. Conclusions The Elecsys® HIV Duo test (Cobase801 analyzer) differentiates the detection of HIV-1 p24 Ag and HIV-1/2 Ab with high specificity and facilitates the diagnosis of patients with early HIV infection. Therefore, the Elecsys®HIV Duo test is used for differentiation of antigen and antibody reactivity, making it suitable for routine clinical diagnosis.
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Data on the Relationships of Signal-To-Cutoff Ratios of Elecsys HIV Antigen/Antibody and Elecsys Syphilis Assays to Subsequent Confirmatory Testing at an Academic Medical Center. Data Brief 2021; 39:107549. [PMID: 34820493 PMCID: PMC8602001 DOI: 10.1016/j.dib.2021.107549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/22/2021] [Accepted: 11/01/2021] [Indexed: 11/22/2022] Open
Abstract
Immunoassays are widely used as screening tests for HIV and syphilis in clinical, public health, and research settings. For syphilis, immunoassays are used in 'reverse syphilis algorithms' that start with treponemal tests such as syphilis IgG or syphilis total antibodies for the initial screen. Many screening immunoassays for HIV and syphilis use signal-to-cutoff (S/CO) values for determining positivity, with a cutoff value such as 1.0 differentiating positive from negative. Published literature indicates that the S/CO value often correlates with the likelihood of subsequent confirmation of HIV and syphilis infections, with low S/CO values barely exceeding the cutoff more likely to represent false positive screens. The data in this article present results from the Roche Diagnostics Elecsys HIV combi PT Assay and the Elecsys Syphilis Assay. The data include 19,368 syphilis total antibody screening results on 15,764 unique patients and 28,952 HIV screening results on 24,556 unique patients, S/CO values, clinical area where testing was ordered, sex, and age. For samples with positive syphilis total antibody screens, the data also include results of RPR (the immediate next step in the reverse algorithm), Treponema pallidum particle agglutination (TP-PA; for those samples in which RPR was non-reactive in the testing cascade), and clinical information and other testing related to diagnosis of syphilis. For positive HIV screens, the data also include HIV antibody differentiation results, HIV-1 PCR or HIV-2 results results (if performed), and clinical information related to diagnosis of HIV. The distributions of S/CO values relative to confirmation status were analyzed.
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Krasowski MD, Wier D, Smith S, Riedel A, Lauseker-Hao Y, Kelner M, Wang S. Real-World Clinical Performance Evaluation of a Fourth-Generation HIV Antigen/Antibody Differentiation Test. J Appl Lab Med 2021; 6:1417-1432. [PMID: 34333654 DOI: 10.1093/jalm/jfab069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 06/01/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND HIV testing is still an important component of routine sexual health screening, assessment of at-risk individuals and as part of the care of pregnant women. To prevent further transmission of infection, it is important that HIV tests are highly sensitive and that positive cases are not missed. HIV serologic antigen/antibody tests are commonly used as they are capable of detecting recent and established infection. METHODS In this study we assessed the performance of the Elecsys HIV Duo assay (Elecsys assay) against the Abbott Architect assay in 10 121 samples from US and non-US adult, pediatric, and pregnant populations including low-risk, high-risk, and known positive cohorts. Congruent repeatedly reactive and/or discrepant samples followed a confirmatory algorithm consisting of an antigen/antibody differentiation assay and a nucleic acid test, as per the study protocol. RESULTS The overall sensitivity of the Elecsys assay was 100.00% (95% CI 99.81-100.00 [1977/1977]), and the specificity was 99.84% (95% CI 99.73-99.91 [8129/8142]). The Elecsys assay detected all positive samples within the study, including all 50 antigen-only positive samples and samples from different HIV subtypes, including group O, group M subtypes, HIV-2 positives, and HIV-1 and HIV-2 dual positives. CONCLUSIONS The Elecsys HIV Duo assay was highly sensitive for diagnosis of HIV in a range of clinical samples from the United States and outside the United States and is suitable for routine use.
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Affiliation(s)
- Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | | | | | | | - Michael Kelner
- Clinical Chemistry and Toxicology Laboratory, University of San Diego Health, San Diego, CA, USA
| | - Sihe Wang
- Pathology and Laboratory Medicine, Akron Children's Hospital, Akron, OH, USA
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Lu X, Zhang M, Liu W, Sheng N, Du Q, Zhang M, Guo X, Wang G, Wang Q. A method to alleviate false-positive results of the Elecsys HIV combi PT assay. Sci Rep 2021; 11:1033. [PMID: 33441741 PMCID: PMC7807026 DOI: 10.1038/s41598-020-80047-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/16/2020] [Indexed: 11/09/2022] Open
Abstract
To explore the effects of urea dissociation on reducing false-positive results of the Elecsys HIV combi PT assay. A retrospective analysis was used to evaluate the false-positive rate of the Elecsys HIV combi PT assay. Six false-positive sera, six positive sera and six sera from patients with early HIV infection were collected. Dissociation was performed using 1 mol/L, 2 mol/L, 4 mol/L, 6 mol/L, or 8 mol/L urea, and HIV screening assay were then detected to select the appropriate concentration of urea dissociation. Next, 55 false-positive sera and 15 sera from early HIV infection were used to verify the best concentration of urea to achieve dissociation. Retrospective analysis showed that the COI of the Elecsys HIV combi PT assay in false-positive sera ranged from 1.0 to 200.0, and approximately 97.01%(227/234) of false-positive sera were in the range of 1.0-15.0. The avidity index (AI) in positive and false-positive sera decreased as the urea dissociation concentration increased. When the dissociation concentration was 6 mol/L, the AI of false-positive serum was between 0.0234 and 0.2567, and the AI of early HIV infection sera was between 0.4325 and 0.5017. The difference in AI between false-positive and positive samples was significant. When negativity was defined as an AI of less than 0.3970, the sensitivity and specificity were 100.0% and 100.0%, respectively. Urea-mediated dissociation could significantly reduce the false-positive rate of the Elecsys HIV combi PT assay with a low COI. Our findings provided a reference for distinguishing positive and false-positive of the Elecsys HIV combi PT assay.
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Affiliation(s)
- Xiaolan Lu
- Department of Laboratory Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China.,College of Laboratory Medicine, North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China.,Faculty of Laboratory Medicine, Center for Translational Medicine, North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China
| | - Minghong Zhang
- Nanchong Center for Disease Control and Prevention, Nanchong, Sichuan, People's Republic of China
| | - Wen Liu
- Department of Laboratory Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China.,College of Laboratory Medicine, North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China.,Faculty of Laboratory Medicine, Center for Translational Medicine, North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China
| | - Nan Sheng
- Nanchong Center for Disease Control and Prevention, Nanchong, Sichuan, People's Republic of China
| | - Qin Du
- Department of Laboratory Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China.,College of Laboratory Medicine, North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China.,Faculty of Laboratory Medicine, Center for Translational Medicine, North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China
| | - Maoxin Zhang
- Department of Laboratory Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China
| | - Xiaolan Guo
- Department of Laboratory Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China.,College of Laboratory Medicine, North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China.,Faculty of Laboratory Medicine, Center for Translational Medicine, North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China
| | - Guangrong Wang
- Department of Laboratory Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China. .,College of Laboratory Medicine, North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China. .,Faculty of Laboratory Medicine, Center for Translational Medicine, North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China.
| | - Qiang Wang
- Department of Laboratory Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China. .,College of Laboratory Medicine, North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China. .,Faculty of Laboratory Medicine, Center for Translational Medicine, North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China.
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Tang Z, Gou Y, Zhang K, Zhao Z, Wei Y, Li D, Chen L, Tao C. The evaluation of low cut-off index values of Elecsys ® HIV combi PT assay in predicting false-positive results. J Clin Lab Anal 2020; 34:e23503. [PMID: 32841422 PMCID: PMC7676207 DOI: 10.1002/jcla.23503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 06/19/2020] [Accepted: 07/13/2020] [Indexed: 02/05/2023] Open
Abstract
Objective To analyze the results of different cut‐off index (COI) values of Elecsys® HIV combi PT assay and to assess the role of COI in reducing the frequency of false‐positive results. Methods We conducted a retrospective study of samples analyzed by Elecsys® HIV combi PT assay, a 4th‐generation ECLIA, between 2016 and 2017. A total amount of 379 122 samples were collected for HIV (Human Immunodeficiency Virus) screening. Results A total of 379 122 samples were analyzed. 2528 (0.67%) were positive by Elecsys® HIV combi PT. Of these, 468 were false‐positive results, and most of them (94.87%) were in samples with 1 < COI < 15. The false‐positive rate was 0.12%. Patients with false‐positive samples were more distributed in elder (P < .001) and female (P < .001) than true‐positive specimens. The median COI in true‐positive specimens was (385.20), which is significantly higher than false‐positive specimens (2.08). The consistency between Elecsys® HIV combi PT assay and 3rd‐generation and positive predictive value (PPV) increased with higher COI values. Cancer, infection, and neurological diseases were considered the potential confounding factors of HIV false‐positive results (19.44%, 11.11%, and 6.62%, respectively). Conclusion Samples with low COI values, especially those contain confounding factors, need to be further scrutinized to determine whether the confounding factors may cause false‐positive problem. In addition, the hypothesis that low COI values may predict false‐positive results is valid.
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Affiliation(s)
- Zhuoyun Tang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yu Gou
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China.,West China Second University Hospital of Sichuan University, Chengdu, China
| | - Keyi Zhang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Zhongyi Zhao
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yinhao Wei
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Dongdong Li
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Li Chen
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China.,Clinical Lab, Wenjiang Zhongyi Hospital, Chengdu, China
| | - Chuanmin Tao
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
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Hodgson CK, Krasowski MD, Ford BA. Data on the relationship of signal-to-cutoff ratio of two HIV antigen/antibody combination assays to subsequent confirmation of HIV-1 infection in a low-prevalence population. Data Brief 2020; 31:105707. [PMID: 32462068 PMCID: PMC7243050 DOI: 10.1016/j.dib.2020.105707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 10/28/2022] Open
Abstract
HIV-1/2 antigen/antibody (Ag/Ab) immunoassays that detect HIV-1 and HIV-2 antibodies and HIV-1 p24 antigen are commonly used in the diagnosis of HIV-1/HIV-2 infections in human plasma/serum. Samples from patients with positive screening results require confirmation by antibody differentiation and/or HIV PCR assays. HIV screening assays are commonly reported as positive or negative based on a signal-to-cutoff (S/CO) threshold. For some HIV screening assays, the strength of the S/CO value correlates with likelihood that confirmatory testing will be positive. The data in this article provide results from two HIV Ag/Ab combination assays (Abbott Architect HIV Ag/Ab Combo Assay, a 4th generation combination assay; Bio-Rad Bioplex 2200 HIV Ag-Ab Assay, a 5th generation assay). The data include 23,331 HIV screening results, S/CO ratios, antibody differentiation or Western blot results (for samples with positive HIV screens), HIV-1 PCR results (if performed), patient location at time of testing, age, and sex. Distribution of S/CO ratios for the Bio-Rad HIV screening assay data and the distribution of S/CO values for samples with positive screening results were analyzed.
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Affiliation(s)
- Christina K Hodgson
- Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Bradley A Ford
- Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
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Masciotra S, Luo W, Rossetti R, Smith T, Ethridge S, Delaney KP, Wesolowski LG, Owen SM. Could HIV-1 RNA Testing be an Option as the Second Step in the HIV Diagnostic Algorithm? Sex Transm Dis 2020; 47:S26-S31. [PMID: 31977972 PMCID: PMC11111260 DOI: 10.1097/olq.0000000000001137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is benefit to early HIV-1 diagnosis and treatment, but there is no Food and Drug Administration-approved quantitative assay with a diagnostic claim. We compared the performance of the Hologic Aptima HIV-1 Quant (APT-Quant) and Aptima HIV-1 Qual (APT-Qual) assays for diagnostic use and the performance of a diagnostic algorithm consisting of Bio-Rad BioPlex 2200 HIV Ag-Ab assay (BPC) followed by APT-Quant (2-test) compared with BPC followed by Geenius HIV-1/2 supplemental assay (Geenius) with reflex to APT-Qual (3-test). METHODS Five hundred twenty-four plasma, which included 419 longitudinal specimens from HIV-1 seroconverters (78 were after initiating antiretroviral therapy [ART]) and 105 from ART-naive persons with established HIV-1 infections, were used to evaluate APT-Quant performance for diagnostic use. Specimens from 200 HIV-negative persons were used to measure specificity. For the algorithm comparison, BPC-reactive specimens were evaluated with the 2-test or 3-test algorithm. McNemar's test was used to compare performance. RESULTS The APT-Quant detected more samples early in infection compared with APT-Qual. The APT-Quant specificity was 99.8%. Before ART initiation, the algorithms performed similarly among samples from different stages of infection. After ART initiation, the 3-test algorithm performed significantly better (P = 0.0233). CONCLUSIONS The APT-Quant has excellent performance for diagnostic use. The 2-test algorithm works well in ART-naive samples, but its performance decreases after the IgG response is elicited and with ART-induced suppressed viremia. Providing confirmation and viral load assay with 1 test result could be advantageous for patient care. However, additional factors and challenges associated with the implementation of this 2-test algorithm, such as cost, specimen type, and collection need further evaluation.
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Affiliation(s)
- Silvina Masciotra
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | - Wei Luo
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | - Rebecca Rossetti
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | - Tara Smith
- ORISE, Oak Ridge, Tennessee, USA/ICF, Atlanta, GA
| | - Steven Ethridge
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | - Kevin P. Delaney
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | | | - S. Michele Owen
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
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Decreased Seroreactivity in Individuals Initiating Antiretroviral Therapy during Acute HIV Infection. J Clin Microbiol 2019; 57:JCM.00757-19. [PMID: 31217270 DOI: 10.1128/jcm.00757-19] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 06/14/2019] [Indexed: 01/24/2023] Open
Abstract
Antiretroviral therapy (ART) during acute HIV infection (AHI) interrupts viral dynamics and may delay the emergence of serological markers targeted by current HIV screening and confirmatory assays, thus creating challenges for correctly classifying HIV infection status. The performance of three HIV antigen/antibody combination (HIV Ag/Ab Combo) assays (the Bio-Rad GS, Abbott Architect, and Bio-Rad BioPlex 2200 assays) was evaluated with samples collected from RV254/South East Asia Research Collaboration in HIV 010 (RV254/SEARCH010) study (Bangkok, Thailand) participants at weeks 12 and 24 following the initiation of ART at Fiebig stage I (FI) (n = 23), FII (n = 39), or FIII/IV (n = 22). Supplemental, confirmatory testing was performed by the Geenius HIV 1/2 and HIV-1 Western blot assays (Bio-Rad). Samples from 30 untreated, HIV-1-infected individuals demonstrated robust HIV Ag/Ab Combo assay reactivity with well-developed HIV-1 Western blotting profiles by 24 weeks after infection. In contrast, 52.2% of samples from individuals initiating ART at FI, 7.7% of samples from individuals initiating ART at FII, and 4.5% of samples from individuals initiating ART at FIII/IV were nonreactive by the HIV Ag/Ab Combo assays, with 36.4 to 39.1% of samples having low signal-to-cutoff (S/CO) results by the Architect and BioPlex assays (S/CO < 10). Seroreversion from a reactive to a nonreactive status was observed in 10 individuals initiating ART at FII and 3 individuals initiating ART at FIII/IV. The Geenius and HIV-1 Western blot assay results were negative or indeterminate for 73.9% and 69.6% of individuals, respectively, treated at FI; 50.0% and 26.3% of individuals, respectively, treated at FII; and 54.5% and 40.9% of individuals, respectively, treated at FIII/IV. Virologic suppression of HIV-1 by ART during AHI impedes seroconversion to biomarkers of infection, limiting the utility of HIV Ag/Ab Combo and supplemental, confirmatory assays for infection status determination.
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