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Li L, Feng X, Zhao F, Yuan D, An X, Tian X, Wu H, Su B, Zhang T, Liu L. Real-world performance of HIV low viral load values in diagnosing acute HIV infection in a tertiary care hospital in Beijing, China. BMC Infect Dis 2024; 24:587. [PMID: 38879487 PMCID: PMC11179375 DOI: 10.1186/s12879-024-09486-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 06/09/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Early diagnosis of HIV infection decreases the time from HIV diagnosis to viral suppression and reduces further HIV transmission. The Chinese Guidelines for the Diagnosis and Treatment of HIV/AIDS (2021 edition) state that an HIV RNA level > 5,000 copies/mL is the threshold for diagnosing HIV infection. The impact of low viral load values on HIV diagnosis needs to be investigated. METHODS There were 3455 human immunodeficiency virus (HIV1 + 2) antibody results (immunoblotting method) and 65,129 HIV viral load values at Beijing Youan Hospital from 2019 to 2022. A total of 2434 patients had both antibody confirmatory results and viral load results. The confirmatory antibody results and HIV viral load results of 2434 patients were analyzed to investigate the impact of low viral load values on HIV diagnosis. RESULTS Of the 2434 patients who had both confirmatory antibody results and viral load results, the viral load values of 140 patients (5.8%) had viral loads ranging from 40 copies/mL to 5,000 copies/mL before positive confirmatory antibody result, and of these 140 patients, the sample receipt time for the viral load tests of 96 (66.7%) individuals was 1 to 6 days earlier than the corresponding sample receipt time for the confirmatory antibody test. In addition, 34 patients (1.4%) had low viral loads ranging from 40 copies/mL to 1,000 copies/mL before positive confirmatory antibody result. CONCLUSION This study revealed that there is a risk of missed diagnosis if a threshold of 5000 copies/mL is used for the diagnosis of HIV infection. These data provide valuable information for the early diagnosis of HIV infection, and our findings have potential benefits for decreasing HIV transmission.
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Affiliation(s)
- Li Li
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Xia Feng
- Department of Clinical Laboratory, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Fei Zhao
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Defu Yuan
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Xizhao An
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Xiaoxue Tian
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Hao Wu
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Bin Su
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.
- Beijing Youan Hospital, Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for Research on Humoral Immune Response to HIV Infection, Clinical and Research Center for Infectious Diseases, Capital Medical University, Beijing, 100069, China.
| | - Tong Zhang
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.
- Beijing Youan Hospital, Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for Research on Humoral Immune Response to HIV Infection, Clinical and Research Center for Infectious Diseases, Capital Medical University, Beijing, 100069, China.
| | - Lifeng Liu
- Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.
- Beijing Youan Hospital, Beijing Key Laboratory for HIV/AIDS Research, Sino-French Joint Laboratory for Research on Humoral Immune Response to HIV Infection, Clinical and Research Center for Infectious Diseases, Capital Medical University, Beijing, 100069, China.
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Landay A, Golub ET, Desai S, Zhang J, Winkelman V, Anastos K, Durkin H, Young M, Villacres MC, Greenblatt RM, Norris PJ, Busch MP. HIV RNA levels in plasma and cervical-vaginal lavage fluid in elite controllers and HAART recipients. AIDS 2014; 28:739-43. [PMID: 24326356 PMCID: PMC4160049 DOI: 10.1097/qad.0000000000000150] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The introduction of HAART leads to control of HIV replication to less than 50 copies/ml, similar to levels in 'elite controllers'. Low-level viral replication may be one of the contributing factors to persistent immune activation/inflammation in HAART-treated individuals. There are still gaps in our knowledge of whether low-level replication persists in systemic versus mucosal sites. DESIGN AND METHODS Participants for this study were recruited from the Women's Interagency HIV Study. We evaluated 33 'elite controllers' who naturally controlled HIV replication and 33 matched HAART-suppressed recipients. This study employed a sensitive target-capture transcription-mediated-amplification assay to compare low-level virus concentrations in plasma and cervical-vaginal lavage (CVL) samples from HIV-positive HAART recipients and 'elite controllers'. RESULTS The median (interquartile range) plasma viral load signal/cut-off (S/Co) for 'elite controllers' was 10.5 (3.9-21.1), which was significantly (P < 0.001) higher than the S/Co for HAART recipients [2.0 (1-4.9)]. The majority of CVL samples from both groups had undetectable HIV RNA and the proportion of CVL samples with a cut-off more than 1.0 was not different between 'elite controllers' and HAART-suppressed recipients. CONCLUSION This study demonstrated persistent low-level HIV replication in 'elite controllers', suggesting potential value of HAART treatment for these individuals. Absent or very low levels of HIV RNA in CVL indicate very low risk of secondary sexual transmission for both groups.
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Affiliation(s)
- Alan Landay
- Department of Immunology/Microbiology, Rush University Medical Center, Chicago, IL
| | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Seema Desai
- Department of Immunology/Microbiology, Rush University Medical Center, Chicago, IL
| | - Jinbing Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Val Winkelman
- Research and Development Support Creative Testing Solutions, Tempe, AZ
| | - Kathryn Anastos
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Helen Durkin
- Center for Allergy and Asthma Research, SUNY Downstate Medical Center, New York, NY
| | - Mary Young
- Division of Infectious Disease, Georgetown University, Washington, DC
| | - Maria C. Villacres
- Department of Pediatrics and Molecular Microbiology and Immunology, University of Southern California, Los Angeles, CA
| | - Ruth M. Greenblatt
- Department of Clinical Pharmacy, Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Philip J. Norris
- Blood Systems Research Institute, Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Michael P. Busch
- Blood Systems Research Institute, Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA
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Hatano H, Yukl SA, Ferre AL, Graf EH, Somsouk M, Sinclair E, Abdel-Mohsen M, Liegler T, Harvill K, Hoh R, Palmer S, Bacchetti P, Hunt PW, Martin JN, McCune JM, Tracy RP, Busch MP, O'Doherty U, Shacklett BL, Wong JK, Deeks SG. Prospective antiretroviral treatment of asymptomatic, HIV-1 infected controllers. PLoS Pathog 2013; 9:e1003691. [PMID: 24130489 PMCID: PMC3795031 DOI: 10.1371/journal.ppat.1003691] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 08/23/2013] [Indexed: 11/19/2022] Open
Abstract
The study of HIV-infected "controllers" who are able to maintain low levels of plasma HIV RNA in the absence of antiretroviral therapy (ART) may provide insights for HIV cure and vaccine strategies. Despite maintaining very low levels of plasma viremia, controllers have elevated immune activation and accelerated atherosclerosis. However, the degree to which low-level replication contributes to these phenomena is not known. Sixteen asymptomatic controllers were prospectively treated with ART for 24 weeks. Controllers had a statistically significant decrease in ultrasensitive plasma and rectal HIV RNA levels with ART. Markers of T cell activation/dysfunction in blood and gut mucosa also decreased substantially with ART. Similar reductions were observed in the subset of "elite" controllers with pre-ART plasma HIV RNA levels below conventional assays (<40 copies/mL). These data confirm that HIV replication persists in controllers and contributes to a chronic inflammatory state. ART should be considered for these individuals (ClinicalTrials.gov NCT01025427).
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Affiliation(s)
- Hiroyu Hatano
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Steven A. Yukl
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America
| | - April L. Ferre
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, Davis, California, United States of America
| | - Erin H. Graf
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Ma Somsouk
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Elizabeth Sinclair
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Mohamed Abdel-Mohsen
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Teri Liegler
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Kara Harvill
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Rebecca Hoh
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Sarah Palmer
- Karolinska Institutet and Swedish Institute for Infectious Disease Control, Solna, Sweden
- Centre for Virus Research, Westmead Millennium Institute and University of Sydney, Westmead, Australia
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Peter W. Hunt
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Jeffrey N. Martin
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Joseph M. McCune
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Russell P. Tracy
- Departments of Pathology and Biochemistry, University of Vermont, Colchester, Vermont, United States of America
| | - Michael P. Busch
- Blood Systems Research Institute, San Francisco, California, United States of America
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Una O'Doherty
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Barbara L. Shacklett
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, Davis, California, United States of America
| | - Joseph K. Wong
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America
| | - Steven G. Deeks
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
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Martin EG, Salaru G, Mohammed D, Coombs RW, Paul SM, Cadoff EM. Finding those at risk: acute HIV infection in Newark, NJ. J Clin Virol 2013; 58 Suppl 1:e24-8. [PMID: 23953941 DOI: 10.1016/j.jcv.2013.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/17/2013] [Accepted: 07/22/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND A screening strategy combining rapid HIV-1/2 (HIV) antibody testing with pooled HIV-1 RNA testing increases identification of HIV infections, but may have other limitations that restrict its usefulness to all but the highest incidence populations. OBJECTIVE By combining rapid antibody detection and pooled nucleic acid amplification testing (NAAT) testing, we sought to improve detection of early HIV-1 infections in an urban Newark, NJ hospital setting. STUDY DESIGN Pooled NAAT HIV-1 RNA testing was offered to emergency department patients and outpatients being screened for HIV antibodies by fingerstick-rapid HIV testing. For those negative by rapid HIV and agreeing to NAAT testing, pooled plasma samples were prepared and sent to the University of Washington where real-time reverse transcription-polymerase chain reaction (RT-PCR) amplification was performed. RESULTS Of 13,226 individuals screened, 6381 had rapid antibody testing alone, and 6845 agreed to add NAAT HIV screening. Rapid testing identified 115 antibody positive individuals. Pooled NAAT increased HIV-1 case detection by 7.0% identifying 8 additional cases. Overall, acute HIV infection yield was 0.12%. While males represent only 48.1% of those tested by NAAT, all samples that screened positive for HIV-1 RNA were obtained from men. CONCLUSION HIV-1 RNA testing of pooled, HIV antibody-negative specimens permits identification of recent infections. In Newark, pooled NAAT increased HIV-1 case detection and provided an opportunity to focus on treatment and prevention messages for those most at risk of transmitting infection. Although constrained by client willingness to participate in testing associated with a need to return to receive further results, use of pooled NAAT improved early infection sensitivity.
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Affiliation(s)
- Eugene G Martin
- UMDNJ - Robert Wood Johnson Medical School, Somerset, NJ, United States(1).
| | - Gratian Salaru
- UMDNJ - Robert Wood Johnson Medical School, Somerset, NJ, United States(1)
| | - Debbie Mohammed
- UMDNJ - New Jersey Medical School, Newark, NJ, United States
| | | | - Sindy M Paul
- New Jersey State Department of Health, Trenton, NJ, United States
| | - Evan M Cadoff
- UMDNJ - Robert Wood Johnson Medical School, Somerset, NJ, United States(1)
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Screening for acute human immunodeficiency virus infection in Baltimore public testing sites. Sex Transm Dis 2012; 38:374-7. [PMID: 21183865 DOI: 10.1097/olq.0b013e31820279bd] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) RNA testing of pooled HIV antibody-negative specimens can identify acute HIV infection (AHI) and trigger interventions to reduce transmission during this highly infectious period. METHODS A Baltimore, MD program serving sexually transmitted disease clinics and other high-risk sites combined HIV testing by third-generation enzyme immunoassay (EIA) with RNA testing of pooled antibody-negative specimens. Laboratory and Disease Intervention Specialists' records were reviewed for program evaluation. A cost analysis was performed. RESULTS In 22 months, we tested 60,695 specimens for HIV. Of these, 1766 (2.9%) tested positive by EIA. Pooled HIV RNA testing of 58,925 EIA-negative specimens detected 7 cases of AHI (0.01%). Reflex HIV RNA testing of EIA-reactive, Western blot-indeterminate specimens confirmed 4 additional AHI cases (total AHI, 0.02%). Contact tracing detected no additional previously unknown cases of HIV infection. CONCLUSIONS The utility of pooled HIV RNA testing may be limited by advances in HIV testing technology that reduce the seronegative window period and by characteristics of the local HIV epidemic.
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Ethridge SF, Wesolowski LG, Nasrullah M, Kennedy MS, Delaney KP, Candal D, Owen SM. Comparative evaluation of Aptima HIV-1 Qualitative RNA assay performance using plasma and serum specimens from persons with established HIV-1 infection. J Clin Virol 2011; 52 Suppl 1:S63-6. [DOI: 10.1016/j.jcv.2011.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Masciotra S, McDougal JS, Feldman J, Sprinkle P, Wesolowski L, Owen SM. Evaluation of an alternative HIV diagnostic algorithm using specimens from seroconversion panels and persons with established HIV infections. J Clin Virol 2011; 52 Suppl 1:S17-22. [PMID: 21981983 DOI: 10.1016/j.jcv.2011.09.011] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The current algorithm for HIV diagnosis in the US involves screening with an immunoassay (IA) and supplemental testing with Western blot (WB) or immunofluorescence assay. Because of existence of more sensitive and specific FDA-approved assays that would also reduce the cost and turn-around time of testing compared to WB, several alternative algorithms have been evaluated. Recently, an alternative algorithm using a sensitive 3rd or 4th generation IA followed by an HIV-1 and HIV-2 discriminatory supplemental test on the initial IA-positive specimens was proposed. Concordant positive results indicate HIV-positive specimens and discordant results are resolved by nucleic acid amplification testing (NAAT). OBJECTIVES To evaluate the sensitivity of assays during acute HIV infection and the performance of the current and an alternative algorithm using samples from HIV-1 seroconversion panels and persons with established HIV infections. STUDY DESIGN To evaluate the algorithms in early infections, 26 HIV-1 seroconverters from the US were tested with three 3rd generation and one 4th generation IA, six rapid tests (RTs), one NAAT, and WB. Sensitivity and specificity of the algorithms were calculated by testing an additional 416 HIV-positive and 414 uninfected control samples with one 3rd generation and one 4th generation IA, four RTs, one NAAT, and WB. RESULTS The individual assays evaluated became positive 5 (RT) to 26 days (NAAT) before WB was positive. Among seroconverters, the alternative algorithm detected significantly more infections than the current algorithm (103-134 versus 56, p<0.0001). Furthermore, the use of a 4th generation IA instead of a 3rd generation assay as the screen resulted in significantly higher detection of acute infections (p<0.0001). In contrast, the algorithms performed equally among specimens from established HIV-1 infections. CONCLUSIONS This study demonstrated improved sensitivity of the alternative algorithm for detecting acute HIV-1 infections, while maintaining the ability to accurately detect established HIV-1 infections. Early detection is important as individuals can be highly infectious during acute infection. In addition, the alternative algorithm should reduce turn-around time by using a RT as the supplemental test has the potential to increase the number of test results returned.
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Affiliation(s)
- Silvina Masciotra
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Atlanta, GA 30333, USA.
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Performance of six commercial enzyme immunoassays and two alternative HIV-testing algorithms for the diagnosis of HIV-1 infection in Kisumu, Western Kenya. J Virol Methods 2011; 176:24-31. [PMID: 21635920 DOI: 10.1016/j.jviromet.2011.05.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 05/11/2011] [Accepted: 05/12/2011] [Indexed: 11/21/2022]
Abstract
Performances of serological parallel and serial testing algorithms were analyzed using a combination of three ELISA and three rapid tests for the confirmation of HIV infection. Each was assessed individually for their sensitivity and specificity on a blinded panel of 769 retrospective sera of known HIV status. Western blot was used as a confirmatory assay for discordant results. Subsequently, one parallel and one serial testing algorithm were assessed on a new panel of 912 HIV-positive and negative samples. Individual evaluation of the ELISAs and rapid tests indicated a sensitivity of 100% for all assays except Uni-Gold with 99.7%. The specificities ranged from 99.1% to 99.4% for rapid assays and from 97.5% to 99.1% for ELISAs. A parallel and serial testing algorithms using Enzygnost and Vironostika, and Determine followed by Uni-Gold respectively, showed 100% sensitivity and specificity. The cost for testing 912 samples was US$4.74 and US$ 1.9 per sample in parallel and serial testing respectively. Parallel or serial testing algorithm yielded a sensitivity and specificity of 100%. This alternative algorithm is reliable and reduces the occurrence of both false negatives and positives. The serial testing algorithm was more cost effective for diagnosing HIV infections in this population.
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Gonçalez TT. Confidential donation confirmation as a alternative exclusion. Rev Bras Hematol Hemoter 2011; 33:251-2. [PMID: 23049310 PMCID: PMC3415753 DOI: 10.5581/1516-8484.20110068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 07/13/2011] [Indexed: 11/30/2022] Open
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Hatano H, Delwart EL, Norris PJ, Lee TH, Neilands TB, Kelley CF, Hunt PW, Hoh R, Linnen JM, Martin JN, Busch MP, Deeks SG. Evidence of persistent low-level viremia in long-term HAART-suppressed, HIV-infected individuals. AIDS 2010; 24:2535-9. [PMID: 20651585 PMCID: PMC2954261 DOI: 10.1097/qad.0b013e32833dba03] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND HAART can effectively reduce plasma HIV RNA levels to below the level of detection in most HIV-infected patients. The degree to which residual low-level viremia persists during HAART remains unclear. METHODS We identified 180 individuals (median duration of HIV infection 12 years) who had at least two consecutive plasma HIV-1 RNA levels below the level of detection (<50-75 copies/ml) while taking antiretroviral drugs; 36 of 180 had been virologically suppressed for more than 5 years. Longitudinal plasma samples that were taken from these individuals during periods of viral load suppression were selected and analyzed. The isothermal transcription-mediated amplification (TMA) (limit of detection <3.5 copies RNA/ml) assay was used to measure persistent viremia. A 'detuned' EIA assay was used to obtain quantitative HIV antibody levels. RESULTS A total of 1606 TMA assays were performed on 438 specimens in 180 HAART-suppressed individuals (median 3 replicates per specimen). In the first year of viral suppression, plasma RNA levels declined significantly (P = 0.001), but after month 12 there was no evidence for a continued decline (P = 0.383). In the first year of viral suppression, HIV antibody levels also declined (P = 0.054), but after month 12 there was no evidence for a continued decline (P = 0.988). CONCLUSION Viremia continued to decline during the first 12 months after viremia became undetectable using conventional methods, and then remained stable. HIV antibody levels also decreased in the first year of viral suppression and then remained stable. Viremia and the HIV-associated host response appear to achieve a steady-state 'set-point' during long-term combination therapy.
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Affiliation(s)
- Hiroyu Hatano
- Department of Medicine, University of California,San Francisco, California, USA.
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Pau CP, Wells SK, Rudolph DL, Owen SM, Granade TC. A rapid real-time PCR assay for the detection of HIV-1 proviral DNA using double-stranded primer. J Virol Methods 2009; 164:55-62. [PMID: 19948189 DOI: 10.1016/j.jviromet.2009.11.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 11/18/2009] [Accepted: 11/23/2009] [Indexed: 11/25/2022]
Abstract
In this study, a rapid real-time PCR assay to detect HIV-1 proviral DNA in whole blood was developed using a novel double-stranded primer that does not require a target-specific fluorescent probe or intercalating dye systems. Co-amplification of a human gene RNase P served as the internal control to monitor the efficiency of the DNA extraction and PCR amplification. The HIV-1 amplification efficiency was 100% and could amplify 1 copy of HIV-1 DNA 64% of the time and all attempts to amplify 4 copies were successful in less than 51 min. All 22 HIV-1 sero-positive and 20 sero-negative whole blood specimens tested were classified correctly by this assay. In addition, 22 cultured PBMC specimens infected with various HIV-1 subtypes or CRF (A=2, AC=1, B=4, C=3, D=3, AE=2, F=1, BF=2, G=4) were amplified equally well with a similar threshold cycle (C(t)) number (22.9+/-1.2). The high amplification efficiency and short PCR cycles were in part due to the short target sequence amplified by eliminating the probe-binding sequence between the primers. This assay may be useful as an alternative confirmation test in a variety of HIV testing venues.
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Affiliation(s)
- Chou-Pong Pau
- Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, United States.
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Kelly JA, Morin SF, Remien RH, Steward WT, Higgins JA, Seal DW, Dubrow R, Atkinson JH, Kerndt PR, Pinkerton SD, Mayer K, Sikkema KJ. Lessons learned about behavioral science and acute/early HIV infection. The NIMH Multisite Acute HIV Infection Study: V. AIDS Behav 2009; 13:1068-74. [PMID: 19504179 DOI: 10.1007/s10461-009-9579-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 05/18/2009] [Indexed: 11/28/2022]
Abstract
Acute/early HIV infection is a period of heightened HIV transmission and a window of opportunity for intervention to prevent onward disease transmission. The NIMH Multisite Acute HIV Infection (AHI) Study was an exploratory initiative aimed at determining the feasibility of recruiting persons with AHI into research, assessing their psychosocial and behavioral characteristics, and examining short-term changes in these characteristics. This paper reports on lessons learned in the study, including: (1) the need to establish the cost-effectiveness of AHI testing; (2) challenges to identifying persons with AHI; (3) the need to increase awareness of acute-phase HIV transmission risks; (4) determining the goals of behavioral interventions following AHI diagnosis; and (5) the need for "rapid response" public health systems that can move quickly enough to intervene while persons are still in the AHI stage. There are untapped opportunities for behavioral and medical science collaborations in these areas that could reduce the incidence of HIV infection.
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Affiliation(s)
- Jeffrey A Kelly
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, 53202, USA.
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13
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Whitney JB, Luedemann C, Bao S, Miura A, Rao SS, Mascola JR, Letvin NL. Monitoring HIV vaccine trial participants for primary infection: studies in the SIV/macaque model. AIDS 2009; 23:1453-60. [PMID: 19550289 PMCID: PMC2776694 DOI: 10.1097/qad.0b013e32832b43d9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The ability to detect and quantify acute HIV-1 infection prior to seroconversion would be an important tool for use in HIV vaccine clinical efficacy trials. We have utilized the SIV/rhesus monkey model to evaluate whether samples more easily obtained than peripheral blood might be used for intensive monitoring of vaccine trial participants. METHODS We have evaluated viral loads in peripheral blood, saliva, feces, and urine of five rhesus monkeys during primary SIVmac251 infection by quantitative real-time PCR. As an alternative to the direct monitoring of frozen samples, we have also developed a fully quantitative viral load assay utilizing dried blood spots. RESULTS Although all compartments were found to harbor viral RNA during primary infection, viral RNA could be detected in the peripheral compartments only when levels of plasma viremia exceed a threshold value of 10 RNA copies/ml. We found no direct correlation between viral burden in plasma and saliva, feces, or urine viral loads. Importantly, both dried saliva and whole blood spots can be used for viral detection. Quantitative whole blood or plasma spotting correlated well with viral burden in plasma during both the acute and set point phase of infection. CONCLUSION Dried blood spots are amenable to rapid quantitative viral load testing. Whole blood spotting has a significant logistical benefit as it requires low blood volumes and no blood processing. Saliva or dried saliva spots or both are potential candidates for acute phase diagnostic screening. These studies indicate the feasibility of intensive monitoring of HIV-1 vaccine trial participants for virus acquisition in resource-limited settings.
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Affiliation(s)
- James B Whitney
- Division of Viral Pathogenesis, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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14
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Abstract
BACKGROUND Persons with acute HIV infection contribute disproportionately to HIV transmission. The identification of these persons is a critical public health challenge. We developed targeted approaches for detecting HIV RNA in persons with negative serological tests. METHODS Persons undergoing publicly funded HIV testing in North Carolina between October 2002 and April 2005 were included in this cross-sectional study. We used logistic regression to develop targeted testing approaches. We also assessed simple approaches based on clinic type and geography. Algorithm development used persons with recent HIV infection, determined by a detuned enzyme-linked immunosorbent assay. Validation used persons with acute HIV infection, identified with an HIV RNA pooling procedure. RESULTS Among 215 528 eligible persons, 232 persons had recent HIV infection and 44 had acute HIV infection. A combination of five indicators (testing site, sexual preference, sex with a person with HIV infection, county HIV incidence, and race) identified 92% of recent infections when testing 50% of the population. In validation among persons with acute HIV infection, this indicator combination had sensitivities of 98% in years 1 and 2 and 88% in year 3. A simple combination of testing site and county performed nearly as well [development (recent infections): sensitivity = 95%; validation (acute infections): sensitivity = 86% in years 1 and 2; 81% in year 3; cut-off established for testing 50% of population.] CONCLUSION Acute HIV infection can be identified accurately using targeted testing. Simple approaches for identifying the types of clinics and geographical areas where infections are concentrated may be logistically feasible and cost-efficient.
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15
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Owen SM, Yang C, Spira T, Ou CY, Pau CP, Parekh BS, Candal D, Kuehl D, Kennedy MS, Rudolph D, Luo W, Delatorre N, Masciotra S, Kalish ML, Cowart F, Barnett T, Lal R, McDougal JS. Alternative algorithms for human immunodeficiency virus infection diagnosis using tests that are licensed in the United States. J Clin Microbiol 2008; 46:1588-95. [PMID: 18322061 PMCID: PMC2395119 DOI: 10.1128/jcm.02196-07] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 01/14/2008] [Accepted: 02/25/2008] [Indexed: 02/05/2023] Open
Abstract
Serodiagnosis of human immunodeficiency virus (HIV) infection in the United States has traditionally relied on a sequential two-test algorithm: an initial screen with an enzyme immunoassay (EIA) and reflex testing of EIA-reactive specimens with a more specific supplemental test such as Western blotting or immunofluorescence. The supplemental tests are tedious, subjective, and expensive. In addition, there have been major improvements in the performance and accuracy of the EIA tests as well as the introduction of rapid serologic tests (RT) and HIV nucleic acid amplification tests (NAAT). Related to these improvements is the possibility that alternative algorithms using combinations of currently approved HIV tests may function as well as if not better than the current algorithm, with more flexibility, improved accuracy, and lower cost. To this end, we evaluated the performance of 12 currently licensed tests and 1 in-house HIV test (6 EIA, 4 RT, and 3 NAAT) on panels of plasma samples from HIV-infected (n = 621 HIV type 1 [HIV-1] and 34 HIV-2) and uninfected (n = 513) people and of sequential specimens from people early in seroconversion (183 specimens from 15 patients). Test combinations were analyzed in two dual-test (sensitivity-optimized and specificity-optimized) algorithms and in a three-test (tie-breaking) algorithm, and performance was compared to the conventional algorithm. The results indicate that alternative algorithm strategies with currently licensed tests compare favorably with the conventional algorithm in detecting and confirming established HIV infection. Furthermore, there was a lower frequency of discordant or indeterminate results that require follow-up testing, and there was improved detection of early infection.
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Affiliation(s)
- S M Owen
- HIV Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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16
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Zetola NM, Mintie A, Liska S, Wong E, Williams JD, Busch MP, Klausner JD. Performance of a transcription-mediated-amplification HIV-1 RNA assay in pooled specimens. J Clin Virol 2007; 40:68-70. [PMID: 17662648 DOI: 10.1016/j.jcv.2007.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Accepted: 06/11/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Very limited data exist on the comparative performance of nucleic acid amplification tests (NATs) for the screening of pooled specimens for acute human immunodeficiency virus (HIV) infection. STUDY DESIGN In this study, we compared a transcription-mediated-amplification assay (Procleix HIV-1 Discriminatory Assay, [TMA]) with a branched DNA assay (Bayer Versant HIV-1 RNA 3.0 assay, [bDNA]). RESULTS After re-testing 1552 samples that were negative for HIV RNA by bDNA, we found one additional positive sample with the TMA assay. CONCLUSION Our results suggest that TMA could potentially detect acute HIV infections missed by other technologies.
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Affiliation(s)
- Nicola M Zetola
- Division of Infectious Diseases, University of California-San Francisco, San Francisco, CA, United States
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17
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Alvarez AM, Rathore MH. Hot topics in pediatric HIV/AIDS. Pediatr Ann 2007; 36:423-32. [PMID: 17691626 DOI: 10.3928/0090-4481-20070701-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ana M Alvarez
- Rainbow Center for Women, Adolescent Children, and Families, USA
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18
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Sherlock M, Zetola NM, Klausner JD. Routine detection of acute HIV infection through RNA pooling: survey of current practice in the United States. Sex Transm Dis 2007; 34:314-6. [PMID: 17483725 DOI: 10.1097/01.olq.0000263262.00273.9c] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jagannathan P, Landovitz R, Roland ME. Postexposure prophylaxis after sexual exposure to HIV. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/17469600.1.1.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Increasing numbers of international, national and state/provincial health organizations in the developed and developing world recommend postexposure prophylaxis (PEP) following potential sexual exposure to HIV. The evidence for these policies is extrapolated from occupational healthcare worker, perinatal prophylaxis and animal studies. There is no direct evidence of PEP efficacy after sexual exposures. Studies addressing potential increases in risk behavior, toxicities and cost–effectiveness are encouraging. Considerations for offering PEP include the timing and characteristics of the exposure and the HIV status of the source and exposed individuals. PEP includes 28 days of a combination antiretroviral drug regimen containing two or more drugs and associated laboratory testing, counseling and referrals. PEP service delivery challenges include ensuring adequate access to services, optimizing PEP adherence and facilitating follow-up HIV testing and counseling. Men who have sex with men, sexual assault survivors, children and adolescents, and individuals in resource-limited settings present unique needs and challenges.
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Affiliation(s)
- Prasanna Jagannathan
- University of California, San Francisco, California, Department of General Internal Medicine, San Francisco General Hospital Ward 13, 1001 Potrero Avenue, San Francisco, CA 94110, USA
| | - Raphael Landovitz
- University of California, Los Angeles, Center for Clinical AIDS Research and Education, David Geffen School of Medicine, 9 911 W Pico Blvd., Suite 980 Los Angeles, CA 90035, USA
| | - Michelle E Roland
- University of California. San Francisco, Positive Health Program, Ward 84, San Francisco General Hospital, 995 Potrero Avenue, San Francisco, CA 94110, USA
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Abstract
The process by which HIV-infected individuals are tested and identified has changed with the evolving HIV epidemic and public health response. In this review, we discuss the rationale for increased HIV testing as well as the current standards in HIV diagnostics and their inherent limitations. Current policy guidelines for routine HIV testing from the U.S. Preventive Services Task Force and the U.S. Centers for Disease Control and Prevention are divergent. However, national momentum toward the implementation of routine HIV testing programs continues based on the efficacy and feasibility of these programs in terms of HIV case identification and on recent reports of their cost-effectiveness. As routine, voluntary HIV screening programs are established, issues surrounding consent, reporting, and stigma still persist, as does the challenge of effectively linking detected HIV cases to care.
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Affiliation(s)
- Lindsey L Wolf
- Division of General Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114, USA
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21
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Abstract
PURPOSE OF REVIEW HIV postexposure prophylaxis is often recommended following potential sexual exposure to HIV. Recent data address the effectiveness of postexposure prophylaxis and prevention counseling, cost-effectiveness, antiretroviral options, challenges with nonoccupational postexposure prophylaxis among adolescents and children and following sexual assault in high HIV prevalence areas, and a successful program in Amsterdam. RECENT FINDINGS Postexposure prophylaxis is not completely protective. Seroconversion may result from antiretroviral failure or from ongoing exposures. Postexposure prophylaxis associated risk reduction counseling results in reductions in subsequent risk behavior. Programs that target outreach and limit prescriptions to those with exposure sources who are at risk of being HIV infected are cost-effective. Less restrictive guidelines result in more prescriptions for low-risk exposures; this practice is not cost-effective. The ideal antiretrovirals for postexposure prophylaxis use have not been established. Tenofovir has several attractive properties. Developing systems to support the effective delivery of postexposure prophylaxis among children and adolescents and following sexual assault in high HIV prevalence, resource limited settings is challenging. SUMMARY Numerous national and international guidelines recommend postexposure prophylaxis following potential sexual exposure to HIV. Maximizing adherence and minimizing subsequent HIV exposures will be critical to enhancing the effectiveness of this HIV prevention intervention.
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Affiliation(s)
- Michelle E Roland
- Positive Health (AIDS) Program at San Francisco General Hospital, University of California, San Francisco, California 94110, USA.
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