Evaluation of a new in-clinic test system to detect feline immunodeficiency virus and feline leukemia virus infection

Epidemiology of Pathogenic Retroviruses and Domestic Cat Hepadnavirus in Community and Client-Owned Cats in Hong Kong

Understanding the local epidemiology of feline leukaemia virus (FeLV) and feline immunodeficiency virus (FIV) in Hong Kong will inform retrovirus prevention strategies. Domestic cat hepadnavirus (DCH), a novel hepatitis-B-like virus, is commonly detected among client-owned cats in Hong Kong, but community cats have not been studied. The aims of this study were to investigate the frequency and potential risk factors for (i) FeLV and FIV among community and client-owned cats and (ii) perform molecular detection of DCH among community cats in Hong Kong. Blood samples from 713 cats were obtained from client-owned (n = 415, residual diagnostic) and community cats (n = 298, at trap-neuter-return). Point-of-care (POC) testing for FeLV antigen and feline immunodeficiency virus (FIV) anti-p15 and p24 antibodies was performed. FeLV-positive samples were progressed to p27 sandwich enzyme-linked immunosorbent assay. Whole blood DNA was tested with qPCRs for FeLV U3 and gag, and nested PCRs where additional information was required. DCH qPCR was performed on a subset of community cats (n = 193). A single, regressive, FeLV infection was detected in a client-owned cat (1/415 FeLV U3 qPCR positive, 0.2%, 95% CI 0.0-1.3%). Five/415 client-owned cats tested presumably false FeLV-antigen positive (qPCR negative). No markers of FeLV infection were detected in community cats (0/298; 0%). FIV seroprevalence was much higher in community cats (46/298, 15.4%) than in client-owned cats (13/415, 3.1%) (p < 0.001). Mixed breed was a risk factor for FIV infection in client-owned cats. Neither sex nor age were associated with FIV infection. DCH DNA was detected in 34/193 (17.6%) community cats (median viral load 6.32 × 103 copies/reaction). FeLV infection is rare in Hong Kong, negatively impacting the positive predictive value of diagnostic tests. FeLV-antigen testing remains the screening test of choice, but confirmation of a positive result using FeLV qPCR is essential. FIV infection is common in community cats and the absence of a sex predisposition, seen previously in cats managed similarly, raises questions about virus-transmission dynamics in these groups. DCH infection is very common in Hong Kong, both in client-owned and community cats, highlighting the importance of understanding the pathogenic potential of this virus for cats.

Diagnostic Accuracy of a Point-of-Care Immunoassay for Feline Immunodeficiency Virus Antibodies, Feline Leukemia Virus Antigen, and Dirofilaria immitis Antigen

Feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV) are retroviral infections of cats worldwide whose clinical manifestations range from mild to severe disease. In both cases, infected cats can live a long life with proper care and should be managed to prevent infection of other cats. Dirofilaria immitis, the nematode that causes heartworm disease, can infect cats in any region where dogs are infected. Though cats are more resistant to infection, clinical diseases in the form of heartworm-associated respiratory disease can cause death. Screening for these infectious diseases enables veterinarians to manage their cases and prevent the spread to other cats. We describe the diagnostic accuracy of a point-of-care immunoassay for FIV, FeLV, and heartworm, compared to reference methods commonly available through reference laboratories to the practicing veterinarian. For FIV, we report 100% sensitivity (95% confidence limits (CL): 96.2-100%) and 97.8% specificity (95% CL: 95.4-99.4%). For FeLV, we report 100% sensitivity (95% CL: 97.7-100%) and 99.2% specificity (95% CL: 97.1-99.9%). And for heartworm, we report 90.2% sensitivity (95% CL: 76.9-97.3%) and 100% specificity (95% CL: 98.3-100%). Veterinarians may expect this performance relative to the reference methods they use for confirmatory serological testing.

[Feline leukemia virus infection - a guide to diagnosis]

Feline leukemia virus (FeLV) infection affects cats worldwide. The course of FeLV infection can change and vary over time. The complex pathogenesis, the availability of many different testing methods, and the interpretation of test results are often challenging for veterinarians. Cats with progressive infection (persistently p27 antigen-positive) shed FeLV mainly through saliva and are therefore considered a source of infection for uninfected cats. Diagnosing regressive infection is often challenging, since it usually cannot be detected by commonly used point of care-tests (p27 antigen test) and thus, it often remains undetected. Nevertheless, cats with regressive infection are FeLV carriers (provirus-positive) and when the immune system is suppressed, reactivation of the infection and FeLV-associated clinical signs can occur. Abortively infected cats are never viraemic, do not shed virus, and do not develop clinical signs. Abortive infection can solely be diagnosed via antibodies detection in blood. A new point-of-care test for the identification of antibodies against FeLV p15E antigen has recently been introduced on the European market and is currently being evaluated.

Feline leukaemia virus infection: A practical approach to diagnosis

PRACTICAL RELEVANCE

Feline leukaemia virus (FeLV) is a retrovirus of domestic cats worldwide. Cats lacking strong FeLV-specific immunity and undergoing progressive infection commonly develop fatal FeLV-associated disease. Many aspects of FeLV infection pathogenesis have been elucidated, some during more recent years using molecular techniques. It is recommended that the FeLV status of every cat is known, since FeLV infection can influence the prognosis and clinical management of every sick cat. Moreover, knowledge of a cat's FeLV status is of epidemiological importance to prevent further spread of the infection.

CLINICAL CHALLENGES

Diagnosing FeLV infection remains challenging due to different outcomes of infection, which can vary over time depending on the balance between the virus and the host's immune system. Furthermore, testing for FeLV infection has become more refined over the years and now includes diagnostic assays for different viral and immunological parameters. Knowledge of FeLV infection pathogenesis, as well as the particulars of FeLV detection methods, is an important prerequisite for correct interpretation of any test results and accurate determination of a cat's FeLV status.

AIMS

The current review presents recent knowledge on FeLV pathogenesis, key features to be determined in FeLV infection, and frequently used FeLV detection methods, and their characteristics and interpretation. An algorithm for the diagnosis of FeLV infection in a single cat, developed by the European Advisory Board on Cat Diseases, is included, and FeLV testing in specific situations is addressed. As well as increasing awareness of this deadly infection in domestic cats, the aim is to contribute diagnostic expertise to allow veterinarians in practice to improve their recognition, and further reduce the prevalence, of FeLV infection.

2020 AAFP Feline Retrovirus Testing and Management Guidelines

CLINICAL IMPORTANCE

Feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) infections are found in cats worldwide. Both infections are associated with a variety of clinical signs and can impact quality of life and longevity.

SCOPE

This document is an update of the 2008 American Association of Feline Practitioners' feline retrovirus management guidelines and represents current knowledge on pathogenesis, diagnosis, prevention and treatment of retrovirus infections in cats.

TESTING AND INTERPRETATION

Although vaccines are available for FeLV in many countries and for FIV in some countries, identification of infected cats remains an important factor for preventing new infections. The retrovirus status of every cat at risk of infection should be known. Cats should be tested as soon as possible after they are acquired, following exposure to an infected cat or a cat of unknown infection status, prior to vaccination against FeLV or FIV, and whenever clinical illness occurs. It might not be possible to determine a cat's infection status based on testing at a single point in time; repeat testing using different methods could be required. Although FeLV and FIV infections can be associated with clinical disease, some infected cats, especially those infected with FIV, can live for many years with good quality of life.

MANAGEMENT OF INFECTED CATS

There is a paucity of data evaluating treatments for infected cats, especially antiretroviral and immunomodulatory drugs. Management of infected cats is focused on effective preventive healthcare strategies, and prompt identification and treatment of illness, as well as limiting the spread of infection.

Decreased Sensitivity of the Serological Detection of Feline Immunodeficiency Virus Infection Potentially Due to Imported Genetic Variants

Feline immunodeficiency virus (FIV) is a lentivirus of domestic cats worldwide. Diagnosis usually relies on antibody screening by point-of-care tests (POCT), e.g., by enzyme-linked immunosorbent assays (ELISA), and confirmation using Western blot (WB). We increasingly observed ELISA-negative, WB-positive samples and aimed to substantiate these observations using 1194 serum/plasma samples collected from 1998 to 2019 primarily from FIV-suspect cats. While 441 samples tested positive and 375 tested negative by ELISA and WB, 81 samples had discordant results: 70 were false ELISA-negative (WB-positive) and 11 were false ELISA-positive (WB-negative); 297 ambiguous results were not analyzed further. The diagnostic sensitivity and specificity of the ELISA (82% and 91%, respectively) were lower than those reported in 1995 (98% and 97%, respectively). The diagnostic efficiency was reduced from 97% to 86%. False ELISA-negative samples originated mainly (54%) from Switzerland (1995: 0%). Sixty-four false ELISA-negative samples were available for POCT (SNAP^TM/WITNESS^R): five were POCT-positive. FIV RT-PCR was positive for two of these samples and was weakly positive for two ELISA- and POCT-negative samples. Low viral loads prohibited sequencing. Our results suggest that FIV diagnosis has become more challenging, probably due to increasing travel by cats and the introduction of new FIV isolates not recognized by screening assays.

Performance of 4 Point-of-Care Screening Tests for Feline Leukemia Virus and Feline Immunodeficiency Virus

Background

More than 3 million cats in the United States are infected with FeLV or FIV. The cornerstone of control is identification and segregation of infected cats.

Hypothesis/Objectives

To compare test performance with well‐characterized clinical samples of currently available FeLV antigen/FIV antibody combination test kits.

Animals

Surplus serum and plasma from diagnostic samples submitted by animal shelters, diagnostic laboratories, veterinary clinics, and cat research colonies. None of the cats had been vaccinated against FIV. The final sample set included 146 FeLV+, 154 FeLV−, 94 FIV+, and 97 FIV− samples.

Methods

Prospective, blind comparison to a gold standard: Samples were evaluated in 4 different point‐of‐care tests by ELISA antigen plate tests (FeLV) and virus isolation (FIV) as the reference standards. All test results were visually read by 2 blinded observers.

Results

Sensitivity and specificity, respectively, for FeLV were SNAP^® (100%/100%), WITNESS^® (89.0%/95.5%), Anigen^® (91.8%/95.5%), and VetScan^® (85.6%/85.7%). Sensitivity and specificity for FIV were SNAP^® (97.9%/99.0%), WITNESS^® (94.7%/100%), Anigen^® (96.8%/99.0%), and VetScan^® (91.5%/99.0%).

Conclusions and Clinical Importance

The SNAP^® test had the best performance for FeLV, but there were no significant differences for FIV. In typical cat populations with seroprevalence of 1–5%, a majority of positive results reported by most point‐of‐care test devices would be false‐positives. This could result in unnecessary segregation or even euthanasia.

Determining the feline immunodeficiency virus (FIV) status of FIV-vaccinated cats using point-of-care antibody kits

This study challenges the commonly held view that the feline immunodeficiency virus (FIV) infection status of FIV-vaccinated cats cannot be determined using point-of-care antibody test kits due to indistinguishable antibody production in FIV-vaccinated and naturally FIV-infected cats. The performance of three commercially available point-of-care antibody test kits was compared in a mixed population of FIV-vaccinated (n=119) and FIV-unvaccinated (n=239) cats in Australia. FIV infection status was assigned by considering the results of all antibody kits in concert with results from a commercially available PCR assay (FIV RealPCR™). Two lateral flow immunochromatography test kits (Witness FeLV/FIV; Anigen Rapid FIV/FeLV) had excellent overall sensitivity (100%; 100%) and specificity (98%; 100%) and could discern the true FIV infection status of cats, irrespective of FIV vaccination history. The lateral flow ELISA test kit (SNAP FIV/FeLV Combo) could not determine if antibodies detected were due to previous FIV vaccination, natural FIV infection, or both. The sensitivity and specificity of FIV RealPCR™ for detection of viral and proviral nucleic acid was 92% and 99%, respectively. These results will potentially change the way veterinary practitioners screen for FIV in jurisdictions where FIV vaccination is practiced, especially in shelter scenarios where the feasibility of mass screening is impacted by the cost of testing.

A survey of feline leukaemia virus antigenaemia among cats in eastern Austria: a retrospective analysis of serum samples routinely tested between 1996 and 2011

Objectives

The aim of this retrospective analysis was to determine the seroprevalence of feline leukaemia virus (FeLV) antigenaemia among owned cats in Vienna and the surrounding area.

Methods

Samples were tested between 1996 and 2011 by the Department of Clinical Virology at the University of Veterinary Medicine, Vienna, Austria. All samples were sent to the university as part of routine diagnostic procedures, either to determine infection in clinically symptomatic individuals or to rule out infection prior to vaccination. To allow for statistical comparison, samples analysed between 2008 and 2011 were pooled into one population (n = 444) and evaluated against samples tested in 1996 (n = 840). Furthermore, analyses of subgroups were undertaken to determine the effect of sex and age on the prevalence of FeLV antigenaemia.

Results

With respect to the samples tested at the University of Veterinary Medicine in Vienna, it was determined that the level of FeLV antigenaemia in eastern Austria between 1996 and 2011 was 5.6%. The proportion of FeLV antigenaemic cats was highly variable and has not fallen significantly over this period, despite advances in vaccination, and the education of pet owners and animal welfare charities.

Conclusions and relevance

This study confirms the importance of continued and regular vaccination against FeLV among Austrian cats, particularly those allowed access to the outdoors. Within the remit of this retrospective study, it was not possible to follow-up results of repeat testing or of other assays (PCR) of individual cats. As a result of this, no conclusions can be drawn as to the possibility of transient antigenaemic cats or false-positive enzyme-linked immunosorbent assay results.

Changes in prevalence of progressive feline leukaemia virus infection in cats with lymphoma in Germany

Progressive infection with feline leukaemia virus (FeLV) is considered one of the major risk factors for development of feline lymphoma. The aim of this study was to compare cats with lymphoma between 1980 and 1994 (first period) and between 1995 and 2009 (second period) concerning FeLV antigenaemia and age distribution. In addition, differences between FeLV antigen-positive and antigen-negative cats with lymphoma regarding patients' characteristics, tumour location and outcome were evaluated. There was a significant decrease in the percentage of lymphoma cases associated with progressive FeLV infection from the first (59 per cent) to the second (13 per cent) observation period. FeLV antigen-positive cats were significantly younger (median 3.7 v 11.3 years), and had significantly shorter response duration (median 25 days v 472 days) with therapy. In the cats of the second period, gastrointestinal and extranodal lymphomas were the most common anatomical sites, and the majority of those cats were FeLV antigen-negative. Thus, other aetiologies than progressive FeLV infection must have a greater impact on cancerogenesis among affected cats with lymphoma to date.