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Stekler JD, Violette LR, Niemann LA, McMahan VM, Katz DA, Chavez PR, Clark HA, Cornelius-Hudson A, McDougal SJ, Delaney KP. Seroconversion, seroreversion, and serowaffling among participants initiating antiretroviral therapy in Project DETECT. Int J STD AIDS 2023; 34:385-394. [PMID: 36703607 DOI: 10.1177/09564624231152929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Incomplete HIV seroconversion and seroreversion are increasingly documented by testing and pre-exposure prophylaxis programs more than previously recognized. This analysis reports on incomplete seroconversion and seroreversion by specimen and test type among Project DETECT participants. METHODS Project DETECT included a longitudinal study of point-of-care tests. Participants were categorized as having "incomplete seroconversion" if all timepoints had ≥1 nonreactive test at study censoring. Among participants with incomplete seroconversion, we defined "seroreversion" as sustained regression to nonreactive for any test following a reactive result. We define "serowaffling" as any reactive result followed by a nonreactive and then reactive result. We used Fisher's exact tests to explore relationships between Fiebig stage at ART initiation and incomplete seroconversion, seroreversion, and serowaffling. RESULTS Twenty of 1940 Project DETECT participants met criteria for this subset. Ten participants had complete seroconversion after a median of 23 (IQR 16-47) days following initial positive tests. Ten participants had incomplete seroconversion, eight of whom had seroreversion. Incomplete seroconversion with persistent nonreactive tests was seen only with oral fluid (OF). Of eight participants with seroreversion, all experienced seroreversion of OF tests if the test was ever reactive (n = 6); seroreversion occurred in fingerstick and venipuncture tests in two participants. Serowaffling occurred in nine (45%) participants. No associations were seen between Fiebig stage at ART start and complete seroconversion, seroregression, or serowaffling in our sample. CONCLUSIONS OF tests may be particularly susceptible to providing false-negative results. Seroreversion and incomplete seroconversion among individuals on antiretroviral treatment may represent a growing problem for HIV testing and treatment programs.
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Affiliation(s)
- Joanne D Stekler
- Department of Medicine, 7284University of Washington, Seattle, WA, USA.,Department of Global Health, 7284University of Washington, Seattle, WA, USA.,Department of Epidemiology, 7284University of Washington, Seattle, WA, USA
| | - Lauren R Violette
- Department of Medicine, 7284University of Washington, Seattle, WA, USA.,Department of Epidemiology, 7284University of Washington, Seattle, WA, USA
| | - Lisa A Niemann
- Department of Medicine, 7284University of Washington, Seattle, WA, USA
| | - Vanessa M McMahan
- 7152San Francisco Department of Public Health, San Francisco, CA, USA
| | - David A Katz
- Department of Global Health, 7284University of Washington, Seattle, WA, USA.,Department of Epidemiology, 7284University of Washington, Seattle, WA, USA
| | - Pollyanna R Chavez
- Division of HIV Prevention, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hollie A Clark
- Division of HIV Prevention, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Sarah J McDougal
- Department of Medicine, 7284University of Washington, Seattle, WA, USA
| | - Kevin P Delaney
- Division of HIV Prevention, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
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2
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Violette LR, Cornelius-Hudson A, Snidarich M, Niemann LA, Assennato SM, Ritchie A, Goel N, Chavez PR, Ethridge SF, Katz DA, Lee H, Delaney KP, Stekler JD. Evaluation of SAMBA II: A Qualitative and Semiquantitative HIV Point-of-Care Nucleic Acid Test. J Acquir Immune Defic Syndr 2022; 89:537-545. [PMID: 34974473 PMCID: PMC9058199 DOI: 10.1097/qai.0000000000002902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Point-of-care (POC) nucleic acid tests (NATs) have potential to diagnose acute HIV infection and monitor persons taking pre-exposure prophylaxis or antiretroviral therapy (ART). POC NATs have not yet been evaluated in the US. METHODS From June 2018-March 2019, we conducted a cross-sectional evaluation of the Simple Amplification-Based Assay version II (SAMBA II) POC NAT. People with HIV (PWH) and persons testing for HIV were tested with the SAMBA II qualitative (Qual) whole blood (WB) test. From April-September 2019, the Qual test was used on persons who were ART-naive, and SAMBA II Semi-quantitative (Semi-Q) WB was used with ART-experienced PWH. Both were performed on unprocessed venipuncture (VP) and, when indicated by protocol, fingerstick (FS) WB and plasma. SAMBA results were compared with Abbott RealTime HIV-1 polymerase chain reaction results on plasma. We calculated sensitivity, specificity, and concordance between tests. RESULTS SAMBA was used in 330 visits among 280 participants: 202 (61.2%) visits from PWH, and 128 (38.8%) from HIV-negative persons. Qual test sensitivity with ART-naive participants was 91.4% [32/35, 95% confidence interval (CI): 77.6% to 97.0%] using VP WB and 100% (27/27, 95% CI: 87.5% to 100%) using FS WB. Specificity was 100% using both specimen types. Concordance between the gold standard and Semi-Q at 1000 copies/mL among PWH on ART was 97.7% (86/88, 95% CI: 92.1% to 99.4%) and 100% (30/30, 95% CI: 88.7% to 100%) using VP and FS WB, respectively. CONCLUSIONS The SAMBA II POC NATs showed high sensitivity, specificity, and concordance with the gold standard assay, indicating its potential use in diagnostics and monitoring. Future work will evaluate POC NAT implementation in the US.
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Affiliation(s)
- Lauren R Violette
- Department of Medicine, University of Washington, Seattle, WA, US
- Department of Epidemiology, University of Washington, Seattle, WA, US
| | | | | | - Lisa A Niemann
- Department of Medicine, University of Washington, Seattle, WA, US
| | | | | | - Neha Goel
- Diagnostics for the Real World Ltd, Cambridge, UK
| | - Pollyanna R Chavez
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, US
| | - Steven F Ethridge
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, US
| | - David A. Katz
- Department of Global Health, University of Washington, Seattle, WA, US
| | - Helen Lee
- Diagnostics for the Real World Ltd, Cambridge, UK
| | - Kevin P Delaney
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, US
| | - Joanne D Stekler
- Department of Medicine, University of Washington, Seattle, WA, US
- Department of Epidemiology, University of Washington, Seattle, WA, US
- Department of Global Health, University of Washington, Seattle, WA, US
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3
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Wagner AD, Kinuthia J, Dettinger J, Mwongeli N, Gómez L, Watoyi S, Drake AL, Abuna F, Pintye J, Ochieng B, Odinga D, John-Stewart G, Baeten JM. Challenges of Discrepant HIV Tests in Pregnant Women in the PrEP era-to Treat or Not to Treat? J Infect Dis 2021; 223:234-237. [PMID: 32561928 DOI: 10.1093/infdis/jiaa343] [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: 04/09/2020] [Accepted: 06/11/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND During HIV retesting in antenatal and preexposure prophylaxis (PrEP) care, discrepant results occur, but guidelines are lacking. METHODS In a Kenyan trial implementing antenatal PrEP, if 1 test is reactive, a second is performed; if discrepant, both are repeated; if persistently discrepant, DNA polymerase chain reaction (PCR) is performed. RESULTS Among 4451 women, 23 265 HIV retesting sessions were performed; 14 (0.06%, 95% confidence interval, 0.03%-0.10%) had discrepant results among 10 individuals; in all 10 initial cases, PCR was negative. CONCLUSIONS Discrepant rapid tests are an expected, rare, and important challenge for antenatal care HIV retesting, with and without PrEP. CLINICAL TRIALS REGISTRATION NCT03070600.
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Affiliation(s)
- Anjuli D Wagner
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - John Kinuthia
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Julia Dettinger
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Nancy Mwongeli
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Laurén Gómez
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Salphine Watoyi
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Alison L Drake
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Felix Abuna
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Ben Ochieng
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Daniel Odinga
- Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
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4
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To KW, Lee SS. A review of reported cases of HIV pre-exposure prophylaxis failure with resultant breakthrough HIV infections. HIV Med 2020; 22:75-82. [PMID: 33140556 DOI: 10.1111/hiv.12989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Early randomized controlled trials (RCTs) have confirmed high efficacy of pre-exposure prophylaxis (PrEP) for preventing HIV infection in men who have sex with men (MSM) with high HIV exposure risk. Nevertheless, some PrEP failure cases have been reported despite adequate drug adherence. This review aims to summarize the common features of PrEP failure cases and discuss the implications of upscaling PrEP programmes. METHODS A search based on articles and clinical trials was conducted through Medline and OVID, with keywords for accessing publications reporting 'true' PrEP failure in the presence of documented adherence to daily regimen of co-formulated tenofovir disoproxil fumarate/emtricitabone. RESULTS Ten cases of 'true' PrEP failure were identified, all of which were preceded by continued practice of condomless anal sex, despite documented adherence. Dried blood spot and/or hair analyses provided supporting evidence of adherence in eight cases. There was strong association of PrEP failure with recurrent or multiple sexually transmitted diseases and infection with resistant HIV viruses. Seroconversion was usually atypical or delayed because of significantly suppressed viral load, making diagnosis a clinical challenge. DISCUSSION Although it is uncommon, 'true' PrEP failure can occur in a real-world situation, contrary to the outcome of early RCTs. Failure to identify HIV infection while on PrEP can potentially lead to the emergence of drug-resistant virus. To achieve effective HIV prevention, PrEP programmes should emphasize safer sexual practice in addition to drug adherence. Early identification of PrEP failure is crucial, which requires the development of highly sensitive assays and their clinical application.
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Affiliation(s)
- K W To
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - S S Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
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5
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Performance evaluation of the MedMira reveal G4 LAB S/P and POC HIV antibody rapid screening tests using plasma and whole blood specimens. J Clin Virol 2020; 127:104344. [PMID: 32305880 DOI: 10.1016/j.jcv.2020.104344] [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: 01/06/2020] [Revised: 03/11/2020] [Accepted: 03/28/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Reveal G4 antibody rapid test is FDA-approved for HIV-1 detection using the versions LAB S/P and POC in CLIA-moderate complexity settings with serum/plasma and whole blood, respectively. The same Reveal tests are CE-marked for HIV-1 and HIV-2 detection in laboratory and point-of-care (POC) settings. OBJECTIVE We compared the performance of G4 LAB S/P with plasma and POC with whole blood (blood) for detecting early and established HIV-1/HIV-2 infections. STUDY DESIGN Matched well-characterized plasma and simulated blood were used to evaluate: sensitivity in 104 HIV-1 and 55 HIV-2 established infections, specificity in 49 HIV-negative, and reactivity in early HIV-1 infection in a performance panel (n=38) and 18 plasma panels from seroconverters (SCs, n=183). Median number of days after first RNA-positive was calculated for 13 SCs. Impact of viral suppression (VS) was evaluated in 3 SCs receiving early antiretroviral therapy (ART). RESULTS Sensitivity was 100 % for HIV-1 and 98.18 % for HIV-2, while specificity was 100 %. All 38 plasma and blood become reactive by Fiebig stage V. Of 18 SCs, 10 had similar reactivity in plasma/blood, 7 showed delayed reactivity in blood, and 1 was nonreactive in plasma/blood. The median days for a G4-reactive after first RNApositive was 13 for plasma and 14 for blood. Long-term VS had no impact on G4 reactivity. CONCLUSIONS Overall reactivity in early HIV-1 infections is delayed by one day in blood compared to plasma. If FDA-approved for POC settings, the G4 POC is a fast sensitive screening tool for HIV-1/HIV-2-specific IgG even during VS.
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6
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Chavez PR, Bradley HM, Wesolowski LG, Violette LR, Katz DA, Niemann LA, McMahan VM, McDougal S, Cornelius-Hudson AM, Ethridge SF, Stekler JD, Delaney KP. Performance evaluation of four point-of-care HIV tests using unprocessed specimens. J Clin Virol 2020; 124:104282. [PMID: 31991321 PMCID: PMC10955760 DOI: 10.1016/j.jcv.2020.104282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/24/2019] [Accepted: 01/15/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The performance of recently approved point-of-care (POC) HIV tests should be assessed using unprocessed specimens. OBJECTIVE To evaluate the sensitivity and specificity of four POC HIV tests using whole blood (WB) and two using oral fluid (OF) among persons recruited from health clinics in Seattle, Washington, during September 2015-September 2017. STUDY DESIGN Participants were tested with the POC tests, additional plasma and serum were collected for laboratory testing, and participant- reported use of antiretroviral therapy (ART) or pre-exposure prophylaxis (PrEP) was recorded. Participants testing negative on all tests could reenroll every 90 days. Specimens from persons previously diagnosed with HIV infection as well as from those who were newly diagnosed during the study were included in the sensitivity estimate. Sensitivity and specificity were calculated based on HIV status determined by laboratory testing. RESULTS Of 1,256 visits, 179 were from persons with HIV infection; 120 of these were taking ART. Among 1,077 visits from participants not diagnosed with HIV, PrEP use was reported at 155 (14.4%) visits. Sensitivity was similar among POC WB tests (95.53%-97.21%; p>0.05). Among participants on ART, sensitivity was lower for the same test performed on OF compared to WB (p<0.003). Specificity was high for all tests (99.44%- 100.00%); we did not detect specificity differences with PrEP use. CONCLUSIONS These POC tests displayed relatively high sensitivity and specificity using unprocessed specimens, suggesting their effectiveness in identifying HIV infections whenever laboratory-based testing is not feasible. Nonetheless, clients with recent risk should retest to rule out the possibility of a false-negative result.
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Affiliation(s)
- Pollyanna R Chavez
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, United States.
| | - Heather M Bradley
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, United States
| | - Laura G Wesolowski
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, United States
| | - Lauren R Violette
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - David A Katz
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Lisa A Niemann
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Vanessa M McMahan
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Sarah McDougal
- Department of Medicine, University of Washington, Seattle, WA, United States
| | | | - Steven F Ethridge
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, United States
| | - Joanne D Stekler
- Department of Medicine, University of Washington, Seattle, WA, United States; Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kevin P Delaney
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, United States
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7
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Stekler JD, Violette LR, Clark HA, McDougal SJ, Niemann LA, Katz DA, Chavez PR, Wesolowski LG, Ethridge SF, McMahan VM, Cornelius-Hudson A, Delaney KP. Prospective Evaluation of HIV Testing Technologies in a Clinical Setting: Protocol for Project DETECT. JMIR Res Protoc 2020; 9:e16332. [PMID: 32012115 PMCID: PMC7011122 DOI: 10.2196/16332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND HIV testing guidelines provided by the Centers for Disease Control and Prevention (CDC) are continually changing to reflect advancements in new testing technology. Evaluation of existing and new point-of-care (POC) HIV tests is crucial to inform testing guidelines and provide information to clinicians and other HIV test providers. Characterizing the performance of POC HIV tests using unprocessed specimens can provide estimates for the window period of detection, or the time from HIV acquisition to test positivity, which allows clinicians and other HIV providers to select the appropriate POC HIV tests for persons who may be recently infected with HIV. OBJECTIVE This paper describes the protocols and procedures used to evaluate the performance of the newest POC tests and determine their sensitivity during early HIV infection. METHODS Project DETECT is a CDC-funded study that is evaluating POC HIV test performance. Part 1 is a cross-sectional, retrospective study comparing behavioral characteristics and HIV prevalence of the overall population of the Public Health-Seattle & King County (PHSKC) Sexually Transmitted Disease (STD) Clinic to Project DETECT participants enrolled in part 2. Part 2 is a cross-sectional, prospective study evaluating POC HIV tests in real time using unprocessed whole blood and oral fluid specimens. A POC nucleic acid test (NAT) was added to the panel of HIV tests in June 2018. Part 3 is a longitudinal, prospective study evaluating seroconversion sensitivity of POC HIV tests through serial follow-up testing. For comparison, HIV-1 RNA and HIV-1/HIV-2 antigen/antibody tests are also performed for participants enrolled in part 2 or 3. A behavioral survey that collects information about demographics, history of HIV testing, STD history, symptoms of acute HIV infection, substance use, sexual behaviors in the aggregate and with recent partners, and use of pre-exposure prophylaxis and antiretroviral therapy is completed at each part 2 or 3 visit. RESULTS Between September 2015 and March 2019, there were 14,990 Project DETECT-eligible visits (part 1) to the PHSKC STD Clinic resulting in 1819 part 2 Project DETECT study visits. The longitudinal study within Project DETECT (part 3) enrolled 27 participants with discordant POC test results from their part 2 visit, and 10 (37%) were followed until they had fully seroconverted with concordant positive POC test results. Behavioral survey data and HIV test results, sensitivity, and specificity will be presented elsewhere. CONCLUSIONS Studies such as Project DETECT are critical for evaluating POC HIV test devices as well as describing characteristics of persons at risk for HIV acquisition in the United States. HIV tests in development, including POC NATs, will provide new opportunities for HIV testing programs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/16332.
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Affiliation(s)
- Joanne D Stekler
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Lauren R Violette
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Hollie A Clark
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sarah J McDougal
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Lisa A Niemann
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - David A Katz
- Department of Global Health, University of Washington, Seattle, WA, United States
- HIV/STD Program, Public Health-Seattle and King County, Seattle, WA, United States
| | - Pollyanna R Chavez
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Laura G Wesolowski
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Steven F Ethridge
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Vanessa M McMahan
- Department of Medicine, University of Washington, Seattle, WA, United States
| | | | - Kevin P Delaney
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
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8
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Repeated false reactive ADVIA centaur® and bio-rad Geenius™ HIV tests in a patient self-administering anabolic steroids. BMC Infect Dis 2020; 20:9. [PMID: 31906866 PMCID: PMC6945705 DOI: 10.1186/s12879-019-4722-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/22/2019] [Indexed: 11/25/2022] Open
Abstract
Background An individual is considered HIV positive when a confirmatory HIV-1/HIV-2 differentiation test returns positive following an initial reactive antigen/antibody combination screen. Falsely reactive HIV screens have been reported in patients with various concomitant infectious and autoimmune conditions. Falsely positive confirmatory HIV differentiation assays are seen less frequently, but have been observed in cases of pregnancy, pulmonary embolism, and malaria. Case presentation A healthy 27 year-old man was referred after a reactive ADVIA Centaur® HIV Ag/Ab screen and positive Bio-Rad Geenius™ HIV 1/2 Confirmatory assay, suggesting HIV-1 infection. The patient’s HIV viral load was undetectable prior to initiation of antiretroviral therapy, and remained undetectable on subsequent testing after initiation of antiretroviral therapy. Both Centaur® and Geenius™ tests were repeated and returned reactive. As this patient was believed to be at low risk of acquiring HIV infection, samples were additionally run on Genscreen™ HIV-1 Ag assay and Fujirebio Inno-LIA™ HIV-1/2 score, with both returning non-reactive. For confirmation, the patient’s proviral HIV DNA testing was negative, confirming the initial results as being falsely positive. The patient disclosed that he had been using a variety of anabolic steroids before and during the time of HIV testing. Discussion and conclusions The erroneous diagnosis of HIV can result in decreased quality of life and adverse effects of antiretroviral therapy if initiated, hence the importance of interpreting the results of HIV testing in the context of an individual patient. This reports suggests a potential association between the use of anabolic steroids and falsely-reactive HIV testing.
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9
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Elliott T, Sanders EJ, Doherty M, Ndung'u T, Cohen M, Patel P, Cairns G, Rutstein SE, Ananworanich J, Brown C, Fidler S. Challenges of HIV diagnosis and management in the context of pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), test and start and acute HIV infection: a scoping review. J Int AIDS Soc 2019; 22:e25419. [PMID: 31850686 PMCID: PMC6918508 DOI: 10.1002/jia2.25419] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/22/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Knowledge of HIV status relies on accurate HIV testing, and is the first step towards access to HIV treatment and prevention programmes. Globally, HIV-status unawareness represents a significant challenge for achieving zero new HIV infections and deaths. In order to enhance knowledge of HIV status, the World Health Organisation (WHO) recommends a testing strategy that includes the use of HIV-specific antibody point-of-care tests (POCT). These POCTs do not detect acute HIV infection, the stage of disease when viral load is highest but HIV antibodies are undetectable. Complicating things further, in the presence of antiretroviral therapy (ART) for pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), other currently available testing technologies, such as viral load detection for diagnosis of acute HIV infection, may yield false-negative results. In this scoping review, we evaluate the evidence and discuss alternative HIV testing algorithms that may mitigate diagnostic dilemmas in the setting of increased utilization of ART for immediate treatment and prevention of HIV infection. DISCUSSION Missed acute HIV infection prevents people living with HIV (PLHIV) from accessing early treatment, increases likelihood of onward transmission, and allows for inappropriate initiation or continuation of PrEP, which may result in HIV drug resistance. While immediate ART is recommended for all PLHIV, studies have shown that starting ART in the setting of acute HIV infection may result in a delayed or complete absence of development of HIV-specific antibodies, posing a diagnostic challenge that is particularly pertinent to resource-limited, high HIV burden settings where HIV-antibody POCTs are standard of care. Similarly, ART used as PrEP or PEP may supress HIV RNA viral load, complicating current HIV testing algorithms in resource-wealthy settings where viral detection is included. As rollout of PrEP continues, HIV testing algorithms may need to be modified. CONCLUSIONS With increasing use of PrEP and ART in acute infection we anticipate diagnostic challenges using currently available HIV testing strategies. Research and surveillance are needed to determine the most appropriate assays and optimal testing algorithms that are accurate, affordable and sustainable.
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Affiliation(s)
- Tamara Elliott
- Imperial College LondonLondonUnited Kingdom
- Imperial College Healthcare NHS TrustLondonUnited Kingdom
| | - Eduard J Sanders
- Kenya Medical Research Institute‐Wellcome Trust Research ProgrammeKilifiKenya
- Nuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Meg Doherty
- Department of HIV and Global Hepatitis ProgrammeWHOGenevaSwitzerland
| | - Thumbi Ndung'u
- Africa Health Research InstituteDurbanSouth Africa
- HIV Pathogenesis ProgrammeDoris Duke Medical Research InstituteUniversity of KwaZulu‐NatalDurbanSouth Africa
- The Ragon Institute of Massachusetts General HospitalMassachusetts Institute of Technology and Harvard UniversityCambridgeMAUSA
- Max Planck Institute for Infection BiologyBerlinGermany
| | - Myron Cohen
- Department of Internal MedicineDivision of Infectious DiseasesUNC School of MedicineUniversity of North Carolina At Chapel HillChapel HillNCUSA
| | - Pragna Patel
- Division of Global HIV and TBCenters for Disease Control and PreventionAtlantaGAUSA
| | - Gus Cairns
- NAM AidsmapLondonUnited Kingdom
- PrEP in Europe InitiativeLondonUnited Kingdom
| | - Sarah E Rutstein
- Department of Internal MedicineDivision of Infectious DiseasesUNC School of MedicineUniversity of North Carolina At Chapel HillChapel HillNCUSA
| | - Jintanat Ananworanich
- U.S. Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringMDUSA
- Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMDUSA
| | - Colin Brown
- National Infection Service, Public Health EnglandLondonUnited Kingdom
- Department of InfectionRoyal Free London NHS Foundation TrustLondonUnited Kingdom
| | - Sarah Fidler
- Imperial College LondonLondonUnited Kingdom
- Imperial College NIHR BRCLondonUnited Kingdom
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10
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Branson BM. HIV Diagnostics: Current Recommendations and Opportunities for Improvement. Infect Dis Clin North Am 2019; 33:611-628. [PMID: 31239094 DOI: 10.1016/j.idc.2019.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Profound changes in technology have revolutionized laboratory testing for human immunodeficiency virus (HIV) since the first laboratory enzyme immunoassays that detected only immunoglobulin G (IgG) antibodies. Instrumented fourth-generation random-access chemiluminescent assays are now recommended for initial screening because they become reactive in as little as 2 weeks after infection. Using HIV-1 RNA viral load assays after a reactive initial test could confirm infection and provide useful clinical information. Early initiation of antiretroviral therapy and use of preexposure prophylaxis can alter the evolution of biomarkers and assay reactivity, leading to ambiguous test results.
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Affiliation(s)
- Bernard M Branson
- Scientific Affairs LLC, 2175 Eldorado Drive, Atlanta, GA 30345, USA.
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