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Metcalfe R, Ragonnet-Cronin M, Bradley-Stewart A, McAuley A, Stubbs H, Ritchie T, O'Hara R, Trayner K, Glover C, Laverty L, Sills L, Brown K, Gunson R, Campbell J, Milsoevic C, Anderson P, Peters SE. From Hospital to the Community: Redesigning the Human Immunodeficiency Virus (HIV) Clinical Service Model to Respond to an Outbreak of HIV Among People Who Inject Drugs. J Infect Dis 2021; 222:S410-S419. [PMID: 32877546 PMCID: PMC7467274 DOI: 10.1093/infdis/jiaa336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
An outbreak of human immunodeficiency virus (HIV) among people who inject drugs in Glasgow, Scotland started in 2014. We describe 156 cases over 5 years and evaluate the impact of clinical interventions using virological and phylogenetic analysis. We established (1) HIV services within homeless health facilities, including outreach nurses, and (2) antiretroviral therapy (ART) via community pharmacies. Implementation of the new model reduced time to ART initiation from 264 to 23 days and increased community viral load suppression rates to 86%. Phylogenetic analysis demonstrated that 2019 diagnoses were concentrated within a single network. Traditional HIV care models require adaptation for this highly complex population.
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Affiliation(s)
- Rebecca Metcalfe
- Brownlee Centre for Infectious Diseases, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom.,School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom.,Public Health Scotland, Glasgow, United Kingdom
| | - Manon Ragonnet-Cronin
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Amanda Bradley-Stewart
- West of Scotland Specialist Virology Centre, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom.,Public Health Scotland, Glasgow, United Kingdom
| | - Harrison Stubbs
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Trina Ritchie
- Glasgow Alcohol and Drug Recovery Services, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Regina O'Hara
- BBV Pharmacy, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Kirsten Trayner
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom.,Public Health Scotland, Glasgow, United Kingdom
| | - Claire Glover
- Brownlee Centre for Infectious Diseases, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Lynn Laverty
- Brownlee Centre for Infectious Diseases, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Laura Sills
- Glasgow Alcohol and Drug Recovery Services, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Kathryn Brown
- BBV Pharmacy, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Rory Gunson
- Consultant Clinical Scientist, West of Scotland Specialist Virology Centre, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - John Campbell
- Alcohol and Drug Partnership, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Catriona Milsoevic
- Public Health Protection Unit, NHS Greater Glasgow and Clyde, Glasgow, Glasgow, United Kingdom
| | - Patricia Anderson
- Brownlee Centre for Infectious Diseases, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - S Erica Peters
- Brownlee Centre for Infectious Diseases, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
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2
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Estcourt C, Yeung A, Nandwani R, Goldberg D, Cullen B, Steedman N, Wallace L, Hutchinson S. Population-level effectiveness of a national HIV preexposure prophylaxis programme in MSM. AIDS 2021; 35:665-673. [PMID: 33290298 PMCID: PMC7924973 DOI: 10.1097/qad.0000000000002790] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/19/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate Scotland's national HIV preexposure prophylaxis (PrEP) programme in relation to PrEP uptake and associated population-level impact on HIV incidence among MSM. DESIGN A retrospective cohort study within real-world implementation. METHODS Comparison of HIV diagnoses from national surveillance data and HIV incidence within a retrospective cohort of HIV-negative MSM attending sexual health clinics from the National Sexual Health information system between the 2-year periods pre(July 2015-June 2017) and post(July 2017-June 2019) introduction of PrEP. RESULTS Of 16 723 MSM attending sexual health services in the PrEP period, 3256 (19.5%) were prescribed PrEP. Between pre-PrEP and PrEP periods, new HIV diagnoses among MSM declined from 229 to 184, respectively [relative risk reduction (RRR): 19.7%, 95% confidence interval (95% CI) 2.5-33.8]; diagnosed recently acquired infections declined from an estimated 73 to 47, respectively (35.6%, 95% CI 7.1-55.4). Among MSM attending sexual health clinics, HIV incidence per 1000 person-years declined from 5.13 (95% CI 3.90-6.64) pre-PrEP to 3.25 (95% CI 2.30-4.47) in the PrEP period (adjusted IRR 0.57, 95% CI 0.37-0.87). Compared with the pre-PrEP period, incidence of HIV was lower in the PrEP period for those prescribed PrEP (aIRR 0.25, 95% CI 0.09-0.70) and for those not prescribed PrEP (aIRR 0.68, 95% CI 0.43-1.05). CONCLUSION We demonstrate national population-level impact of PrEP for the first time in a real-world setting. HIV incidence reduced in MSM who had been prescribed PrEP and, to a lesser extent, in those who had not. Promotion of the benefits of PrEP needs to extend to MSM who do not access sexual health clinics.
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Affiliation(s)
- Claudia Estcourt
- Glasgow Caledonian University
- NHS Greater Glasgow & Clyde, Glasgow
| | - Alan Yeung
- Glasgow Caledonian University
- Public Health Scotland, Glasgow
| | - Rak Nandwani
- NHS Greater Glasgow & Clyde, Glasgow
- University of Glasgow, Glasgow
| | - David Goldberg
- Glasgow Caledonian University
- Public Health Scotland, Glasgow
- University of Glasgow, Glasgow
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3
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Lewis PE, Poteet EC, Liu D, Chen C, LaBranche CC, Stanfield-Oakley SA, Montefiori DC, Ferrari G, Yao Q. CTLA-4 Blockade, during HIV Virus-Like Particles Immunization, Alters HIV-Specific B-Cell Responses. Vaccines (Basel) 2020; 8:E284. [PMID: 32517277 PMCID: PMC7349993 DOI: 10.3390/vaccines8020284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/31/2020] [Accepted: 06/03/2020] [Indexed: 12/23/2022] Open
Abstract
Studies have shown that blockade of CTLA-4 promoted the expansion of germinal center B-cells in viral infection or immunization with model antigens. Few studies have evaluated the immunological consequences of CTLA-4 blockade during immunization against relevant vaccine candidates. Here, we investigated the effects of CTLA-4 blockade on HIV virus-like particles (VLPs) vaccination in a C57BL/6J mouse model. We found that CTLA-4 blockade during HIV VLP immunization resulted in increased CD4+ T-cell activation, promoted the expansion of HIV envelope (Env)-specific follicular helper T cell (Tfh) cells, and significantly increased HIV Gag- and Env-specific IgG with higher avidity and antibody-dependent cellular cytotoxicity (ADCC) capabilities. Furthermore, after only a single immunization, CTLA-4 blockade accelerated T-cell dependent IgG class switching and the induction of significantly high serum levels of the B-cell survival factor, A proliferation-inducing ligand (APRIL). Although no significant increase in neutralizing antibodies was observed, increased levels of class-switched Env- and Gag-specific IgG are indicative of increased polyclonal B-cell activation, which demonstrated the ability to mediate and enhance ADCC in this study. Altogether, our findings show that CTLA-4 blockade can increase the levels of HIV antigen-specific B-cell and antigen-specific Tfh cell activity and impact humoral immune responses when combined with a clinically relevant HIV VLP-based vaccine.
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Affiliation(s)
- Phoebe E. Lewis
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA; (P.E.L.); (E.C.P.); (D.L.); (C.C.)
- Interdepartmental Program in Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Ethan C. Poteet
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA; (P.E.L.); (E.C.P.); (D.L.); (C.C.)
| | - Dongliang Liu
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA; (P.E.L.); (E.C.P.); (D.L.); (C.C.)
| | - Changyi Chen
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA; (P.E.L.); (E.C.P.); (D.L.); (C.C.)
| | - Celia C. LaBranche
- Duke Human Vaccine Institute, Departments of Medicine, Immunology, Surgery, and Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27708, USA; (C.C.L.); (S.A.S.-O.); (D.C.M.); (G.F.)
| | - Sherry A. Stanfield-Oakley
- Duke Human Vaccine Institute, Departments of Medicine, Immunology, Surgery, and Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27708, USA; (C.C.L.); (S.A.S.-O.); (D.C.M.); (G.F.)
| | - David C. Montefiori
- Duke Human Vaccine Institute, Departments of Medicine, Immunology, Surgery, and Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27708, USA; (C.C.L.); (S.A.S.-O.); (D.C.M.); (G.F.)
| | - Guido Ferrari
- Duke Human Vaccine Institute, Departments of Medicine, Immunology, Surgery, and Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC 27708, USA; (C.C.L.); (S.A.S.-O.); (D.C.M.); (G.F.)
| | - Qizhi Yao
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA; (P.E.L.); (E.C.P.); (D.L.); (C.C.)
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
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4
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Alex D, Raj Williams TI, Sachithanandham J, Prasannakumar S, Demosthenes JP, Ramalingam VV, Victor PJ, Rupali P, Fletcher GJ, Kannangai R. Performance of a Modified In-House HIV-1 Avidity Assay among a Cohort of Newly Diagnosed HIV-1 Infected Individuals and the Effect of ART on the Maturation of HIV-1 Specific Antibodies. Curr HIV Res 2020; 17:134-145. [PMID: 31309891 DOI: 10.2174/1570162x17666190712125606] [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] [Received: 04/17/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Viral kinetics impact humoral immune response to HIV; antibody avidity testing helps distinguish recent (<6 months) and long-term HIV infection. This study aims to determine the frequency of recent HIV-1 infection among clients attending ICTC (Integrated Counselling and Testing Centre) using a commercial EIA, to correlate it with a modified in-house avidity assay and to study the impact of ART on anti-HIV-1 antibody maturation. METHODS Commercial LAg Avidity EIA was used to detect antibody avidity among 117 treatment naïve HIV-1 infected individuals. A second-generation HIV ELISA was modified for in-house antibody avidity testing and cutoff was set based on Receiver Operating Characteristic (ROC) analysis. Archived paired samples from 25 HIV-1 infected individuals before ART and after successful ART; samples from 7 individuals responding to ART and during virological failure were also tested by LAg Avidity EIA. RESULTS Six individuals (5.1%) were identified as recently infected by a combination of LAg avidity assay and HIV-1 viral load testing. The modified in-house avidity assay demonstrated sensitivity and specificity of 100% and 98.2%, respectively, at AI=0.69 by ROC analysis. Median ODn values of individuals when responding to ART were significantly lower than pre-ART [4.136 (IQR 3.437- 4.827) vs 4.455 (IQR 3.748-5.120), p=0.006] whereas ODn values were higher during virological failure [4.260 (IQR 3.665 - 4.515) vs 2.868 (IQR 2.247 - 3.921), p=0.16]. CONCLUSION This modified in-house antibody avidity assay is an inexpensive method to detect recent HIV-1 infection. ART demonstrated significant effect on HIV-1 antibody avidity owing to changes in viral kinetics.
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Affiliation(s)
- Diviya Alex
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | | | | | | | - John Paul Demosthenes
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | | | - Punitha John Victor
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | | | - Rajesh Kannangai
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
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5
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Ragonnet-Cronin M, Jackson C, Bradley-Stewart A, Aitken C, McAuley A, Palmateer N, Gunson R, Goldberg D, Milosevic C, Leigh Brown AJ. Recent and Rapid Transmission of HIV Among People Who Inject Drugs in Scotland Revealed Through Phylogenetic Analysis. J Infect Dis 2019; 217:1875-1882. [PMID: 29546333 DOI: 10.1093/infdis/jiy130] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 03/08/2018] [Indexed: 11/13/2022] Open
Abstract
Background Harm reduction has dramatically reduced HIV incidence among people who inject drugs (PWID). In Glasgow, Scotland, <10 infections/year have been diagnosed among PWID since the mid-1990s. However, in 2015 a sharp rise in diagnoses was noted among PWID; many were subtype C with 2 identical drug-resistant mutations and some displayed low avidity, suggesting the infections were linked and recent. Methods We collected Scottish pol sequences and identified closely related sequences from public databases. Genetic linkage was ascertained among 228 Scottish, 1820 UK, and 524 global sequences. The outbreak cluster was extracted to estimate epidemic parameters. Results All 104 outbreak sequences originated from Scotland and contained E138A and V179E. Mean genetic distance was <1% and mean time between transmissions was 6.7 months. The average number of onward transmissions consistently exceeded 1, indicating that spread was ongoing. Conclusions In contrast to other recent HIV outbreaks among PWID, harm reduction services were not clearly reduced in Scotland. Nonetheless, the high proportion of individuals with a history of homelessness (45%) suggests that services were inadequate for those in precarious living situations. The high prevalence of hepatitis C (>90%) is indicative of sharing of injecting equipment. Monitoring the epidemic phylogenetically in real time may accelerate public health action.
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Affiliation(s)
| | | | | | | | - Andrew McAuley
- Health Protection Scotland, Glasgow.,Glasgow Caledonian University, United Kingdom
| | - Norah Palmateer
- Health Protection Scotland, Glasgow.,Glasgow Caledonian University, United Kingdom
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6
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Sarkar S, Piepenbrink MS, Basu M, Thakar J, Keefer MC, Hessell AJ, Haigwood NL, Kobie JJ. IL-33 enhances the kinetics and quality of the antibody response to a DNA and protein-based HIV-1 Env vaccine. Vaccine 2019; 37:2322-2330. [PMID: 30926296 PMCID: PMC6506229 DOI: 10.1016/j.vaccine.2019.03.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/05/2019] [Accepted: 03/21/2019] [Indexed: 12/12/2022]
Abstract
Induction of a sustained and broad antibody (Ab) response is a major goal in developing a protective HIV-1 vaccine. DNA priming alone shows reduced levels of immunogenicity; however, when combined with protein boosting is an attractive vaccination strategy for induction of humoral responses. Using the VC10014 DNA and protein-based vaccine consisting of HIV-1 envelope (Env) gp160 plasmids and trimeric gp140 proteins derived from an HIV-1 clade B infected subject who developed broadly neutralizing serum Abs, and which has been previously demonstrated to induce Tier 2 heterologous neutralizing Abs in rhesus macaques, we evaluated whether MPLA and IL-33 when administered during the DNA priming phase enhances the humoral response in mice. The addition of IL-33 during the gp160 DNA priming phase resulted in high titer gp120-specific plasma IgG after the first immunization. The IL-33 treated mice had higher plasma IgG Ab avidity, breadth, and durability after DNA and protein co-immunization with alum adjuvant as compared to MPLA and alum only treated mice. IL-33 was also associated with a significant IgM Env-specific response and expansion of peritoneal and splenic B-1b B cells. These results indicate that DNA priming in the presence of exogenous IL-33 qualitatively alters the HIV-1 Env-specific humoral response, improving the kinetics and breadth of potentially protective Ab.
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Affiliation(s)
- Sanghita Sarkar
- Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY, United States
| | - Michael S Piepenbrink
- Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY, United States
| | - Madhubanti Basu
- Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY, United States
| | - Juilee Thakar
- Department of Microbiology & Immunology, University of Rochester Medical Center, Rochester, NY, United States
| | - Michael C Keefer
- Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY, United States
| | - Ann J Hessell
- Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, United States
| | - Nancy L Haigwood
- Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, United States
| | - James J Kobie
- Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY, United States.
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7
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Morrison CS, Homan R, Mack N, Seepolmuang P, Averill M, Taylor J, Osborn J, Dailey P, Parkin N, Ongarello S, Mastro TD. Assays for estimating HIV incidence: updated global market assessment and estimated economic value. J Int AIDS Soc 2018; 20. [PMID: 29165892 PMCID: PMC5810336 DOI: 10.1002/jia2.25018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 10/02/2017] [Indexed: 01/01/2023] Open
Abstract
Introduction Accurate incidence estimates are needed to characterize the HIV epidemic and guide prevention efforts. HIV Incidence assays are cost‐effective laboratory assays that provide incidence estimates from cross‐sectional surveys. We conducted a global market assessment of HIV incidence assays under three market scenarios and estimated the economic value of improved incidence assays. Methods We interviewed 27 stakeholders, and reviewed journal articles, working group proceedings, and manufacturers’ sales figures. We determined HIV incidence assay use in 2014, and estimated use in 2015 to 2017 and in 5 to 10‐years under three market scenarios, as well as the cost of conducting national and key population surveys using an HIV incidence assay with improved performance. Results Global 2014 HIV incidence assay use was 308,900 tests, highest in Asia and mostly for case‐ and population‐based surveillance. Estimated 2015 to 2017 use was 94,475 annually, with declines due to China and the United States discontinuing incidence assay use for domestic surveillance. Annual projected 5 to 10 year use under scenario 1 – no change in technology – was 94,475. For scenario 2 – a moderately improved incidence assay – projected annual use was 286,031. Projected annual use for scenario 3 – game‐changing technologies with an HIV incidence assay part of (a) standard confirmatory testing, and (b) standard rapid testing, were 500,000 and 180 million, respectively. As HIV incidence assay precision increases, decreased sample sizes required for incidence estimation resulted in $5 to 23 million annual reductions in survey costs and easily offset the approximately $3 million required to develop a new assay. Conclusions Improved HIV incidence assays could substantially reduce HIV incidence estimation costs. Continued development of HIV incidence assays with improved performance is required to realize these cost benefits.
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Affiliation(s)
| | - Rick Homan
- Global Health, Population and Nutrition, FHI 360, Durham, NC, USA
| | - Natasha Mack
- Global Health, Population and Nutrition, FHI 360, Durham, NC, USA
| | | | | | - Jamilah Taylor
- Global Health, Population and Nutrition, FHI 360, Durham, NC, USA
| | - Jennifer Osborn
- HIV/HCV Department, The Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Peter Dailey
- HIV/HCV Department, The Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Neil Parkin
- HIV/HCV Department, The Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Stefano Ongarello
- HIV/HCV Department, The Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Timothy D Mastro
- Global Health, Population and Nutrition, FHI 360, Durham, NC, USA
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8
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Suligoi B, Regine V, Raimondo M, Rodella A, Terlenghi L, Caruso A, Bagnarelli P, Capobianchi MR, Zanchetta N, Ghisetti V, Galli C. HIV avidity index performance using a modified fourth-generation immunoassay to detect recent HIV infections. Clin Chem Lab Med 2017; 55:2010-2019. [PMID: 28672745 DOI: 10.1515/cclm-2016-1192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/05/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Detecting recent HIV infections is important to evaluate incidence and monitor epidemic trends. We aimed to evaluate the diagnostic performance and accuracy of the avidity index (AI) for discriminating for recent HIV infections. METHODS We collected serum samples from HIV-1 positive individuals: A) with known date of infection (midpoint in time between last HIV-negative and first HIV-positive test); B) infected for >1 year. Samples were divided into two aliquots: one diluted with phosphate buffered saline (PBS) and the other with 1 M guanidine. Both aliquots were assayed by the Architect HIV Ag/Ab Combo 4th generation assay (Abbott). We compared AI found in recent (RI=<6 months from seroconversion) and established (EI) infections. The diagnostic accuracy was evaluated by receiver operating characteristic (ROC) curve analysis. The proportion of samples misclassified as recent (FRR) was calculated. RESULTS In total, 647 samples were collected: 455 in group A (51.6% RI and 48.4% EI) and 192 in group B. Among these, sixteen samples were from elite controllers, 294 from treated patients, 328 from patients infected with non-B subtypes. Samples before antiretroviral initiation showed a mean AI significantly lower among RI compared to EI (0.66+0.28 vs. 1.00±0.12; p<0.000). The FRR was 0% using a cut-off of ≤0.70. An extremely low FRR was observed among elite controllers, samples with low VL or CD4. HIV subtype had no impact on AI misclassifications. All individuals in group A reached the AI threshold of 0.80 within 24 months after seroconversion. CONCLUSIONS The AI is an accurate serological marker for discriminating recent from established HIV infections and meets WHO requirements for HIV incidence assays.
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9
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Shepherd SJ, Black H, Thomson EC, Gunson RN. HIV positive patient with GBS-like syndrome. JMM Case Rep 2017; 4:e005107. [PMID: 29026634 PMCID: PMC5610709 DOI: 10.1099/jmmcr.0.005107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/21/2017] [Indexed: 12/17/2022] Open
Abstract
Introduction. Guillain-Barré Syndrome (GBS) is an acute demyelinating polyneuropathy which can occur post-infection. Criteria of diagnosis of GBS include areflexia with progressive bilateral weakness in arms and legs. GBS can lead to severe respiratory and cardiac complications. The fatality rate can be up to 5 % in patients, depending on the severity of the symptoms. HIV can cause a range of neurological disorders including, on rare occasions, GBS. GBS can occur at any stage of HIV infection, highlighting the complexity of diagnosis of GBS within HIV patients. Case presentation. A 57 year old female with lumbar back pain radiating to the legs, poor mobility and tiredness, with reports of a viral-like illness four days previously, was initially diagnosed with a lower respiratory tract infection and discharged. Seventeen days later the patient was readmitted to hospital with progressive lower and upper limb weakness, areflexia and sensory loss. She was diagnosed with GBS and was unexpectedly discovered to be HIV-positive. HIV avidity was low indicating a recently acquired HIV infection. The patient was treated with intravenous immunoglobulin for five days for the GBS and commenced antriretrovirals for HIV. The patient was discharge from hospital 53 days after admission with walking aids and regular physiotherapy follow-up. CONCLUSION . This case highlighted the need for all clinicians to be aware that patients with symptoms of GBS, regardless of clinical history should be offered an HIV test. GBS can be the first sign a patient is HIV-positive.
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Affiliation(s)
- Samantha J Shepherd
- West of Scotland Specialist Virology Centre, Level 5, New Lister Building, 10-16 Alexandra Parade, Glasgow G31 2ER, UK
| | - Heather Black
- Infectious Diseases Unit, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus Research, Stoker Building, 464 Bearsden Road, Glasgow G61 1QH, UK
| | - Rory N Gunson
- West of Scotland Specialist Virology Centre, Level 5, New Lister Building, 10-16 Alexandra Parade, Glasgow G31 2ER, UK
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10
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Bradley-Stewart A, Urcia C, MacLean A, Aitken C, Gunson R. HIV-1 integrase inhibitor resistance among treatment naïve patients in the West of Scotland. J Clin Virol 2017; 92:7-10. [PMID: 28494325 DOI: 10.1016/j.jcv.2017.04.012] [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] [Received: 09/22/2016] [Revised: 03/14/2017] [Accepted: 04/16/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Transmitted integrase inhibitor resistance is rare, with only a small number of cases reported world-wide to date. OBJECTIVES The aim of this study was to assess whether transmitted integrase inhibitor resistance has occurred in Scotland and if so, could there be a case for performing genotypic integrase resistance testing at baseline. STUDY DESIGN The study population consisted of 106 treatment naïve, newly diagnosed, HIV positive patients. The patient samples were collected between October 2015 and March 2016 at the time of HIV diagnosis and prior to initiation of anti-retroviral therapy. The integrase region was amplified and sequenced. RESULTS We detected integrase inhibitor resistance (T66I/T) at baseline in one patient sample. This is a non-polymorphic mutation seen in patients receiving elvitegravir which confers high-level resistance to elvitegravir and intermediate resistance to raltegravir. A further 10 patients had accessory mutations which have minimal or no effect on susceptibility to integrase inhibitors. CONCLUSIONS Transmitted integrase inhibitor resistance remains rare. The results of the present study do not support performing integrase resistance testing at baseline.
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Affiliation(s)
- A Bradley-Stewart
- West of Scotland Specialist Virology Centre, Level 5, New Lister Building, 10-16 Alexandra Parade, Glasgow G31 2ER, United Kingdom.
| | - C Urcia
- West of Scotland Specialist Virology Centre, Level 5, New Lister Building, 10-16 Alexandra Parade, Glasgow G31 2ER, United Kingdom
| | - A MacLean
- West of Scotland Specialist Virology Centre, Level 5, New Lister Building, 10-16 Alexandra Parade, Glasgow G31 2ER, United Kingdom
| | - C Aitken
- West of Scotland Specialist Virology Centre, Level 5, New Lister Building, 10-16 Alexandra Parade, Glasgow G31 2ER, United Kingdom
| | - R Gunson
- West of Scotland Specialist Virology Centre, Level 5, New Lister Building, 10-16 Alexandra Parade, Glasgow G31 2ER, United Kingdom
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11
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Moving towards a reliable HIV incidence test - current status, resources available, future directions and challenges ahead. Epidemiol Infect 2016; 145:925-941. [PMID: 28004622 DOI: 10.1017/s0950268816002910] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In 2011 the Incidence Assay Critical Path Working Group reviewed the current state of HIV incidence assays and helped to determine a critical path to the introduction of an HIV incidence assay. At that time the Consortium for Evaluation and Performance of HIV Incidence Assays (CEPHIA) was formed to spur progress and raise standards among assay developers, scientists and laboratories involved in HIV incidence measurement and to structure and conduct a direct independent comparative evaluation of the performance of 10 existing HIV incidence assays, to be considered singly and in combinations as recent infection test algorithms. In this paper we report on a new framework for HIV incidence assay evaluation that has emerged from this effort over the past 5 years, which includes a preliminary target product profile for an incidence assay, a consensus around key performance metrics along with analytical tools and deployment of a standardized approach for incidence assay evaluation. The specimen panels for this evaluation have been collected in large volumes, characterized using a novel approach for infection dating rules and assembled into panels designed to assess the impact of important sources of measurement error with incidence assays such as viral subtype, elite host control of viraemia and antiretroviral treatment. We present the specific rationale for several of these innovations, and discuss important resources for assay developers and researchers that have recently become available. Finally, we summarize the key remaining steps on the path to development and implementation of reliable assays for monitoring HIV incidence at a population level.
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Kirkpatrick AR, Patel EU, Celum CL, Moore RD, Blankson JN, Mehta SH, Kirk GD, Margolick JB, Quinn TC, Eshleman SH, Laeyendecker O. Development and Evaluation of a Modified Fourth-Generation Human Immunodeficiency Virus Enzyme Immunoassay for Cross-Sectional Incidence Estimation in Clade B Populations. AIDS Res Hum Retroviruses 2016; 32:756-62. [PMID: 26988426 DOI: 10.1089/aid.2015.0198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Accurate methods for cross-sectional incidence estimation are needed for HIV surveillance and prevention research. We developed an avidity assay based on the fourth-generation Genetic Systems HIV Combo Ag/Ab EIA (Bio-Rad Combo assay) and evaluated its performance. MATERIALS AND METHODS The Bio-Rad Combo assay was modified incubating samples with and without 0.025 M diethylamine (DEA). The avidity index (AI) was calculated as the ratio of the DEA-treated to untreated result for a specific sample. We analyzed 2,140 samples from 808 individuals from the United States with known duration of HIV infection. The mean duration of recent infection (MDRI) and the false-recent rate (FRR, fraction of samples from individuals known to be infected >2 years misclassified as recent) were calculated for AI cutoffs of 20%-90% for the avidity assay alone and in combination with a viral load assay (VL, limit of detection 400 copies/ml). Factors associated with misclassification of samples collected ≥2 years after infections were also evaluated. RESULTS The MDRI for the Bio-Rad Combo Avidity assay ranged from 50 days using an AI cutoff of 20% to 276 days using an AI cutoff of 90%; the FRR ranged from 0% to 9%. When samples with a VL <400 copies/ml were classified as nonrecent, the FRRs were reduced approximately twofold and the MDRI estimates were reduced by ∼20%. An AI cutoff of 50% provided an MDRI of 135 days with an FRR of 2.1%. All samples from elite suppressors had an AI >80%. In adjusted analysis, viral suppression and low CD4 cell count were significantly associated with misclassification among individuals infected >2 years. CONCLUSIONS This modified Bio-Rad Combo Avidity assay may be a useful tool for cross-sectional HIV incidence estimation. Further research is needed to evaluate use of this assay in combination with other assays to accurately estimate population-level HIV incidence.
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Affiliation(s)
- Allison R. Kirkpatrick
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland
| | - Eshan U. Patel
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland
| | - Connie L. Celum
- Department of Medicine, University of Washington, Seattle, Washington
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joel N. Blankson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joseph B. Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Thomas C. Quinn
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan H. Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Oliver Laeyendecker
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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