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Inciarte A, Ugarte A, Martínez-Rebollar M, Torres B, Fernández E, Berrocal L, Laguno M, De la Mora L, De Lazzari E, Callau P, Chivite I, González-Cordón A, Solbes E, Rico V, Barrero L, Blanco JL, Martínez E, Ambrosioni J, Mallolas J. Doravirine/Lamivudine/Tenofovir Disoproxil Fumarate for Nonoccupational HIV-1 Postexposure Prophylaxis: A Prospective Open-Label Trial (DORAVIPEP). Open Forum Infect Dis 2023; 10:ofad374. [PMID: 37539061 PMCID: PMC10394723 DOI: 10.1093/ofid/ofad374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023] Open
Abstract
Background New regimens may provide better tolerability, convenience, and safety for nonoccupational human immunodeficiency virus (HIV) postexposure prophylaxis (PEP). For this reason, we evaluated the single-tablet regimen of doravirine/lamivudine/tenofovir disoproxil fumarate (DOR/3TC/TDF) for 28 days. Methods This was a prospective, open-label, single-arm trial including individuals with potential HIV-1 exposure within 72 hours. The primary endpoint was noncompletion of PEP at day 28. Secondary endpoints were adverse effects, adherence, and rate of seroconversion. We performed follow-up at day 7, week 4, and week 12. Results Between September 2019 and March 2022, the study enrolled 399 individuals. Median age was 30 (interquartile range [IQR], 27-36) years, and 91% (n = 364) were male. The mode of exposure was sex between men in 84% (n = 331) of cases; risk assessment for HIV-1 transmission was considered as "high" in 97% (n = 385) of the participants. Median time from exposure to consultation was 24 (IQR, 13-40) hours. Noncompletion of PEP was 29% (n = 114) (95% confidence interval [CI], 24%-33%) and 20% (n = 72) (95% CI, 16%-25%) per modified intention-to-treat. Main reasons for noncompletion were loss to follow-up (n = 104 [91%]) and intolerance (n = 8 [7%]). Older age was associated with a lower risk of premature discontinuation (OR, 0.94; P < .001). One hundred twenty-three (31%) participants reported adverse events, mostly mild and self-limited (82%); discontinuation occurred in 8 cases (2%). Adherence to PEP in the assessed users was 96%. There were no HIV seroconversions. Conclusions DOR/3TC/TDF is a well-tolerated option for nonoccupational PEP. Clinical Trials Registration. NCT04233372.
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Affiliation(s)
- Alexy Inciarte
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
| | - Ainoa Ugarte
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - María Martínez-Rebollar
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Berta Torres
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Emma Fernández
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Leire Berrocal
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Montserrat Laguno
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Lorena De la Mora
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
| | - Elisa De Lazzari
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Pilar Callau
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Iván Chivite
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Ana González-Cordón
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Estela Solbes
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Verónica Rico
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Laura Barrero
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - José Luis Blanco
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Esteban Martínez
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Juan Ambrosioni
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Josep Mallolas
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
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Prakash R, Krishnamurthy Yashaswini M. Streamlining Laboratory Tests for HIV Detection. Infect Dis (Lond) 2022. [DOI: 10.5772/intechopen.105096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
HIV is a retrovirus that primarily infects CD4 presenting cells of the human immune system, such as macrophages and dendritic cells. People die of AIDS because the disease remains undetected for long periods of time. HIV diagnostic testing has come a long way since it was introduced in the early 1980s. Early diagnosis is key to successful treatment of HIV. Assay selection is based on initial screening results and clinical information provided by the physician, both of which are essential for the laboratory’s ability to make accurate diagnoses. Detecting HIV with high specificity and sensitivity in the early stages of infection requires simple, accurate and economical methods. In this chapter we have described the indications & criteria’s for HIV testing, HIV diagnosis by utilizing variety of immunological and molecular methods, like ELISA, rapid diagnostics, Western blotting, indirect immunoassays, and nucleic acid-based tests. Diagnostic laboratories must use testing algorithms to ensure the accuracy of results and the optimal use of lab resources. Participation in laboratory quality assurance programs are also essential to ensure that diagnostic laboratories provide accurate, timely and clinically relevant test results. HIV testing is the first step in maintaining a healthy life and preventing HIV transmission.
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Medina-De la Garza CE, Castro-Corona MDLÁ, Salinas-Carmona MC. Near misdiagnosis of acute HIV-infection with ELISA-Western Blot scheme: Time for mindset change. IDCases 2021; 25:e01168. [PMID: 34094866 PMCID: PMC8167227 DOI: 10.1016/j.idcr.2021.e01168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 11/18/2022] Open
Abstract
Many health care providers still rely upon the ELISA-Western blot scheme for HIV-diagnosis. Western blot may fail to detect an acute HIV-infection. Point of Care settings using rapid tests should consider anamnesis and patient risk assessment for an accurate HIV-Testing. Discordant HIV-testing results require knowledgeable counseling. Health care providers should be aware and updated about changes in HIV-testing guidelines.
Some HIV-infection diagnostic guidelines and health care providers still rely on the ELISA-Western blot diagnostic algorithm. We present a near misdiagnosis case with discordant test results and a lack of proper counseling. We point out the need for an assertive update of health care providers on diagnostic HIV-tests
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Affiliation(s)
- Carlos Eduardo Medina-De la Garza
- Immunology Service, School of Medicine and University Hospital “Dr. José E González”, Universidad Autónoma de Nuevo León, Av Gonzalitos 235, Mitras Centro, Monterrey 64460, Mexico
- Center for Research and Development in Health Sciences, CIDICS, Universidad Autónoma de Nuevo León. Av Gonzalitos s/n Mitras Centro, Monterrey 64460, Mexico
- Corresponding author at: Immunology Service, School of Medicine and University Hospital “Dr. José E González”, Universidad Autónoma de Nuevo León, Mexico.
| | - María de los Ángeles Castro-Corona
- Immunology Service, School of Medicine and University Hospital “Dr. José E González”, Universidad Autónoma de Nuevo León, Av Gonzalitos 235, Mitras Centro, Monterrey 64460, Mexico
- Center for Research and Development in Health Sciences, CIDICS, Universidad Autónoma de Nuevo León. Av Gonzalitos s/n Mitras Centro, Monterrey 64460, Mexico
| | - Mario César Salinas-Carmona
- Immunology Service, School of Medicine and University Hospital “Dr. José E González”, Universidad Autónoma de Nuevo León, Av Gonzalitos 235, Mitras Centro, Monterrey 64460, Mexico
- Corresponding author
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Performance of an Alternative Laboratory-Based HIV Diagnostic Testing Algorithm Using HIV-1 RNA Viral Load. Sex Transm Dis 2021; 47:S18-S25. [PMID: 31895304 DOI: 10.1097/olq.0000000000001124] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since 2014, the recommended algorithm for laboratory diagnosis of HIV infection in the United States has consisted of an HIV-1/2 antigen/antibody (Ag/Ab) test followed by an HIV-1/2 antibody (Ab) differentiation test and, if necessary, a diagnostic HIV-1 nucleic acid test to resolve discordant or indeterminate results. METHODS Using stored specimens from persons seeking HIV testing who had not received a previous diagnosis or treatment, we compared the performance of a 3-step alternative algorithm consisting of an Ag/Ab test followed by a quantitative HIV-1 RNA viral load assay and, if viral load is not detected, an Ab differentiation test, to that of the recommended algorithm. We calculated the sensitivity and specificity of 5 Ag/Ab tests and the proportion of specimens correctly classified by the alternative algorithm compared with the recommended algorithm. Results were examined separately for specimens classified as early infection, established infection, and false-reactive screening. RESULTS Sensitivity and specificity were similar among all Ag/Ab tests. Viral load quantification correctly classified all specimens from early infection, all false-reactive screening specimens, and the majority of specimens from established infection. CONCLUSIONS Although cost, regulatory barriers, test availability, and the ability to differentiate early from established infection must be considered, this alternative algorithm can potentially decrease the total number of tests performed and reduce turnaround time, thereby streamlining HIV diagnosis and initiation of treatment.
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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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Facente SN, Busch MP, Grebe E, Pilcher CD, Welte A, Rice B, Murphy G. Challenges to the performance of current HIV diagnostic assays and the need for centralized specimen archives: a review of the Consortium for the Evaluation and Performance of HIV Incidence Assays (CEPHIA) repository. Gates Open Res 2019; 3:1511. [PMID: 31460496 PMCID: PMC6706958 DOI: 10.12688/gatesopenres.13048.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2019] [Indexed: 11/20/2022] Open
Abstract
Background: New challenges for diagnosis of HIV infection abound, including the impact on key viral and immunological markers of HIV vaccine studies, pre-exposure prophylaxis usage and breakthrough infections, and very early initiation of anti-retroviral treatment. These challenges impact the performance of current diagnostic assays, and require suitable specimens for development and evaluation. In this article we review and describe an archive developed by the Consortium for the Evaluation and Performance of HIV Incidence Assays (CEPHIA), in order to identify the critical features required to create a centralized specimen archive to support these current and future developments. Review and Findings: We review and describe the CEPHIA repository, a large, consolidated repository comprised of over 31,000 highly-selected plasma samples and other body fluid specimen types, with over 50 purposely designed specimen panels distributed to 19 groups since 2012. The CEPHIA repository provided financial return on investment, supported the standardization of HIV incidence assays, and informed guidance and standards set by the World Health Organization and UNAIDS. Unified data from extensively characterized specimens has allowed this resource to support biomarker discovery, assay optimization, and development of new strategies for estimating duration of HIV infection. Critical features of a high-value repository include 1) extensively-characterized samples, 2) high-quality clinical background data, 3) multiple collaborations facilitating ongoing sample replenishment, and 4) sustained history of high-level specimen utilization. Conclusion: With strong governance and leadership, a large consolidated archive of samples from multiple studies provides investigators and assay developers with easy access to diverse samples designed to address challenges associated with HIV diagnosis, helping to enable improvements to HIV diagnostic assays and ultimately elimination of HIV. Its creation and ongoing utilization should compel funders, institutions and researchers to address and improve upon current approaches to sharing specimens.
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Affiliation(s)
- Shelley N. Facente
- University of California, San Francisco, San Francisco, CA, 94110, USA
- Vitalant Research Institute (formerly Blood Systems Research Institute), San Francisco, CA, 94118, USA
- Facente Consulting, Richmond, CA, 94804, USA
| | - Michael P. Busch
- University of California, San Francisco, San Francisco, CA, 94110, USA
- Vitalant Research Institute (formerly Blood Systems Research Institute), San Francisco, CA, 94118, USA
| | - Eduard Grebe
- University of California, San Francisco, San Francisco, CA, 94110, USA
- Vitalant Research Institute (formerly Blood Systems Research Institute), San Francisco, CA, 94118, USA
- The South African DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | | | - Alex Welte
- The South African DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Brian Rice
- London School of Hygiene and Tropical Medicine, London, UK
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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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A generalizable method for estimating duration of HIV infections using clinical testing history and HIV test results. AIDS 2019; 33:1231-1240. [PMID: 30870196 DOI: 10.1097/qad.0000000000002190] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine the precision of new and established methods for estimating duration of HIV infection. DESIGN A retrospective analysis of HIV testing results from serial samples in commercially available panels, taking advantage of extensive testing previously conducted on 53 seroconverters. METHODS We initially investigated four methods for estimating infection timing: method 1, 'Fiebig stages' based on test results from a single specimen; method 2, an updated '4th gen' method similar to Fiebig stages but using antigen/antibody tests in place of the p24 antigen test; method 3, modeling of 'viral ramp-up' dynamics using quantitative HIV-1 viral load data from antibody-negative specimens; and method 4, using detailed clinical testing history to define a plausible interval and best estimate of infection time. We then investigated a 'two-step method' using data from both methods 3 and 4, allowing for test results to have come from specimens collected on different days. RESULTS Fiebig and '4th gen' staging method estimates of time since detectable viremia had similar and modest correlation with observed data. Correlation of estimates from both new methods (3 and 4), and from a combination of these two ('two-step method') was markedly improved and variability significantly reduced when compared with Fiebig estimates on the same specimens. CONCLUSION The new 'two-step' method more accurately estimates timing of infection and is intended to be generalizable to more situations in clinical medicine, research, and surveillance than previous methods. An online tool is now available that enables researchers/clinicians to input data related to method 4, and generate estimated dates of detectable infection.
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Nucleic acid testing and molecular characterization of HIV infections. Eur J Clin Microbiol Infect Dis 2019; 38:829-842. [PMID: 30798399 DOI: 10.1007/s10096-019-03515-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/14/2019] [Indexed: 01/21/2023]
Abstract
Significant advances have been made in the molecular assays used for the detection of human immunodeficiency virus (HIV), which are crucial in preventing HIV transmission and monitoring disease progression. Molecular assays for HIV diagnosis have now reached a high degree of specificity, sensitivity and reproducibility, and have less operator involvement to minimize risk of contamination. Furthermore, analyses have been developed for the characterization of host gene polymorphisms and host responses to better identify and monitor HIV-1 infections in the clinic. Currently, molecular technologies including HIV quantitative and qualitative assays are mainly based on the polymerase chain reaction (PCR), transcription-mediated amplification (TMA), nucleic acid sequence-based amplification (NASBA), and branched chain (b) DNA methods and widely used for HIV detection and characterization, such as blood screening, point-of-care testing (POCT), pediatric diagnosis, acute HIV infection (AHI), HIV drug resistance testing, antiretroviral (AR) susceptibility testing, host genome polymorphism testing, and host response analysis. This review summarizes the development and the potential utility of molecular assays used to detect and characterize HIV infections.
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HIV Testing in the Emergency Department. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40138-018-0161-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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