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Wandera A, Ssekatawa K, Kato CD, Kwizera E, Mujinya P, Siida R. HIV-1 virion lysis following centrifugation improves the sensitivity of the Fourth-Generation HIV Ag/Ab combo assay. BMC Res Notes 2024; 17:153. [PMID: 38835056 DOI: 10.1186/s13104-024-06810-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 05/20/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVE Fourth-generation HIV Ag/Ab Combo assay is used for HIV screening of blood for transfusion in developing countries, however, the sensitivity of the assay is questionable during the acute phase of HIV infection. Thus, the study aimed to determine the effect of combining centrifugation with HIV-1 virion lysis on the sensitivity of the fourth-generation HIV Ag/Ab combo assay. RESULTS When the 50 HIV-1 antibody-negative samples were run on the fourth-generation HIV Ag/Ab combo assay, 8 (16%) were positive following centrifugation, 13 (26%) were positive following lysis while 25 (50%) were positive after combining centrifugation with HIV-1 virion lysis.
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Affiliation(s)
- Allan Wandera
- Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University, Western-Campus, P.O Box 71, Bushenyi, Uganda
| | - Kenneth Ssekatawa
- Department of Science, Technical and Vocational Education, Makerere University, P. O. Box 7062, Kampala, Uganda.
- Africa Center Excellence in Materials Product Development and Nanotechnology (MAPRONANO ACE), Makerere University, P. O. Box 7062, Kampala, Uganda.
| | - Charles Drago Kato
- Department of Biotechnical and Diagnostic Sciences, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Eliah Kwizera
- Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University, Western-Campus, P.O Box 71, Bushenyi, Uganda
| | - Pastori Mujinya
- Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University, Western-Campus, P.O Box 71, Bushenyi, Uganda
| | - Robert Siida
- Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University, Western-Campus, P.O Box 71, Bushenyi, Uganda
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Gray ER, Bain R, Varsaneux O, Peeling RW, Stevens MM, McKendry RA. p24 revisited: a landscape review of antigen detection for early HIV diagnosis. AIDS 2018; 32:2089-2102. [PMID: 30102659 PMCID: PMC6139023 DOI: 10.1097/qad.0000000000001982] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
: Despite major advances in HIV testing, early detection of infection at the point of care (PoC) remains a key challenge. Although rapid antibody PoC and laboratory-based nucleic acid amplification tests dominate the diagnostics market, the viral capsid protein p24 is recognized as an alternative early virological biomarker of infection. However, the detection of ultra-low levels of p24 at the PoC has proven challenging. Here we review the landscape of p24 diagnostics to identify knowledge gaps and barriers and help shape future research agendas. Five hundred and seventy-four research articles to May 2018 that propose or evaluate diagnostic assays for p24 were identified and reviewed. We give a brief history of diagnostic development, and the utility of p24 as a biomarker in different populations such as infants, the newly infected, those on preexposure prophylaxis and self-testers. We review the performance of commercial p24 assays and consider elements such as immune complex disruption, resource-poor settings, prevalence, and assay antibodies. Emerging and ultrasensitive assays are reviewed and show a number of promising approaches but further translation has been limited. We summarize studies on the health economic benefits of using antigen testing. Finally, we speculate on the future uses of high-performance p24 assays, particularly, if available in self-test format.
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Affiliation(s)
- Eleanor R Gray
- London Centre for Nanotechnology, Faculty of Maths and Physical Sciences, University College London
| | - Robert Bain
- Department of Materials, Department of Bioengineering and Institute of Biomedical Engineering, Imperial College London
| | | | | | - Molly M Stevens
- Department of Materials, Department of Bioengineering and Institute of Biomedical Engineering, Imperial College London
| | - Rachel A McKendry
- London Centre for Nanotechnology, Faculty of Maths and Physical Sciences, University College London
- Division of Medicine, University College London, London, UK
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Wessman MJ, Theilgaard Z, Katzenstein TL. Determination of HIV status of infants born to HIV-infected mothers: A review of the diagnostic methods with special focus on the applicability of p24 antigen testing in developing countries. ACTA ACUST UNITED AC 2011; 44:209-15. [DOI: 10.3109/00365548.2011.627569] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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dos Ramos Farías MS, Garcia MN, Dilernia D, Rabinovich RD, Avila MM. Centrifugation improves the detection of HIV-1 p24 antigen in plasma from children born to mothers infected with HIV-1. J Virol Methods 2009; 158:6-10. [PMID: 19187789 DOI: 10.1016/j.jviromet.2009.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 12/19/2008] [Accepted: 01/13/2009] [Indexed: 11/29/2022]
Abstract
Detection of HIV proteins and/or nucleic acids is necessary for the diagnosis of perinatal HIV infection. Despite its low sensitivity, detection of p24 antigen in plasma is a simple and economic method for the diagnosis of HIV in exposed children. The aim of this study was to improve the sensitivity of detection of p24 using centrifugation of plasma. Forty-seven selected stored samples from 37 children (23 infected, 14 uninfected, median age of 137 days) were examined. Plasma samples (volume 0.3-1.5 ml) were defrosted, centrifuged at 23,500 x g at 4 degrees C for 60 min and determination of p24 was carried out in the resuspended pellet (0.12 ml). In 32 plasma samples from infected children, p24 was found originally in 6 (18.7%) and resulted positive in 24 (75%) pellets. When only one sample per child was considered, sensitivity was significantly higher in pellets, 3/23 uncentrifuged plasma samples and 15/23 pellets (McNemar Test, p<0.001). Specificity was 100%. The absorbance/cut-off ratio was always higher in the pellets from positive children (p=0.028). Plasma samples with volumes of 1 ml or more achieved a higher sensitivity (91.7% vs. 36.4%, p=0.009). Centrifugation of plasma samples prior to determination of p24 in pediatric patients resulted in a significant increase in sensitivity.
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Affiliation(s)
- María Sol dos Ramos Farías
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Paraguay, Buenos Aires, Argentina
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Abstract
The objectives of this technical report are to describe methods of diagnosis of HIV-1 infection in children younger than 18 months in the United States and to review important issues that must be considered by clinicians who care for infants and young children born to HIV-1-infected women. Appropriate HIV-1 diagnostic testing for infants and children younger than 18 months differs from that for older children, adolescents, and adults because of passively transferred maternal HIV-1 antibodies, which may be detectable in the child's bloodstream until 18 months of age. Therefore, routine serologic testing of these infants and young children is generally only informative before the age of 18 months if the test result is negative. Virologic assays, including HIV-1 DNA or RNA assays, represent the gold standard for diagnostic testing of infants and children younger than 18 months. With such testing, the diagnosis of HIV-1 infection (as well as the presumptive exclusion of HIV-1 infection) can be established within the first several weeks of life among nonbreastfed infants. Important factors that must be considered when selecting HIV-1 diagnostic assays for pediatric patients and when choosing the timing of such assays include the age of the child, potential timing of infection of the child, whether the infection status of the child's mother is known or unknown, the antiretroviral exposure history of the mother and of the child, and characteristics of the virus. If the mother's HIV-1 serostatus is unknown, rapid HIV-1 antibody testing of the newborn infant to identify HIV-1 exposure is essential so that antiretroviral prophylaxis can be initiated within the first 12 hours of life if test results are positive. For HIV-1-exposed infants (identified by positive maternal test results or positive antibody results for the infant shortly after birth), it has been recommended that diagnostic testing with HIV-1 DNA or RNA assays be performed within the first 14 days of life, at 1 to 2 months of age, and at 3 to 6 months of age. If any of these test results are positive, repeat testing is recommended to confirm the diagnosis of HIV-1 infection. A diagnosis of HIV-1 infection can be made on the basis of 2 positive HIV-1 DNA or RNA assay results. In nonbreastfeeding children younger than 18 months with no positive HIV-1 virologic test results, presumptive exclusion of HIV-1 infection can be based on 2 negative virologic test results (1 obtained at > or = 2 weeks and 1 obtained at > or = 4 weeks of age); 1 negative virologic test result obtained at > or = 8 weeks of age; or 1 negative HIV-1 antibody test result obtained at > or = 6 months of age. Alternatively, presumptive exclusion of HIV-1 infection can be based on 1 positive HIV-1 virologic test with at least 2 subsequent negative virologic test results (at least 1 of which is performed at > or = 8 weeks of age) or negative HIV-1 antibody test results (at least 1 of which is performed at > or = 6 months of age). Definitive exclusion of HIV-1 infection is based on 2 negative virologic test results, 1 obtained at > or = 1 month of age and 1 obtained at > or = 4 months of age, or 2 negative HIV-1 antibody test results from separate specimens obtained at > or = 6 months of age. For both presumptive and definitive exclusion of infection, the child should have no other laboratory (eg, no positive virologic test results) or clinical (eg, no AIDS-defining conditions) evidence of HIV-1 infection. Many clinicians confirm the absence of HIV-1 infection with a negative HIV-1 antibody assay result at 12 to 18 months of age. For breastfeeding infants, a similar testing algorithm can be followed, with timing of testing starting from the date of complete cessation of breastfeeding instead of the date of birth.
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Fiscus SA, Wiener J, Abrams EJ, Bulterys M, Cachafeiro A, Respess RA. Ultrasensitive p24 antigen assay for diagnosis of perinatal human immunodeficiency virus type 1 infection. J Clin Microbiol 2007; 45:2274-7. [PMID: 17475763 PMCID: PMC1933021 DOI: 10.1128/jcm.00813-07] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We evaluated an ultrasensitive p24 antigen enzyme immunosorbent assay on 802 plasma specimens from 582 infants and children of 0 to 180 days of age. Overall sensitivity and specificity were 91.7% and 98.5%, respectively. After exclusion of infants of less than 7 days of age, the sensitivity and specificity were 93.7% and 98.3%, respectively.
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Affiliation(s)
- Susan A Fiscus
- University of North Carolina at Chapel Hill, Department of Microbiology and Immunology, Chapel Hill, North Carolina, USA.
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Praharaj AK. Problems in Diagnosis of HIV Infection in Babies. Med J Armed Forces India 2006; 62:363-6. [PMID: 27688543 PMCID: PMC5034159 DOI: 10.1016/s0377-1237(06)80110-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2004] [Accepted: 06/11/2005] [Indexed: 12/01/2022] Open
Abstract
Serological diagnosis of human immunodeficiency virus (HIV) infection in babies born to HIV infected mothers is difficult because of presence of maternal anti-HIV antibody up to 18 months. Conventional enzyme-linked immunosorbent assay (ELISA) and western blot may be positive in un-infected cases. Various other modalities which have been adopted include detection of HIV specific IgA, IgM, IgE, detection of p24 antigen, viral culture and detection of HIV nucleic acid by polymerase chain reaction (PCR). Viral culture or PCR positivity within first 48 hours of life indicates intrauterine infection. An early diagnosis of HIV infection in babies born to HIV infected mothers is essential as definite antiretroviral therapy (ART) can be instituted and unnecessary toxicity of drug therapy avoided if found negative. Though viral culture and DNA-PCR has sensitivity of >95% after one month of age, some cases can not be diagnosed during this period. Other tests like viral RNA detection by reverse transcription polymerase chain reaction (RT-PCR) and combination of tests will be required.
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Affiliation(s)
- A K Praharaj
- Senior Advisor (Pathology & Microbiology), Command Hospital (SC), Pune
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Read JS, Rich KC, Korelitz JJ, Mofenson LM, Harris R, Moye JH, Meyer WA, Pahwa SG, Bethel JW, Nugent RP. Quantification of human immunodeficiency virus type 1 p24 antigen and antibody rivals human immunodeficiency virus type 1 RNA and CD4+ enumeration for prognosis. National Institute of Child Health and Human Development Intravenous Immunoglobulin Clinical Trial Study Group. Pediatr Infect Dis J 2000; 19:544-51. [PMID: 10877171 DOI: 10.1097/00006454-200006000-00011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The sensitivity, specificity and positive predictive value of baseline serum concentrations of HIV-1 immune complex-dissociated (ICD) p24 antigen for predicting disease progression and mortality were assessed and compared with results obtained for HIV-1 ICD p24 antigen with HIV-1 p24 antibody and for HIV-1 RNA with CD4+ lymphocyte percent. METHODS Data from HIV-infected children enrolled in a North American clinical trial (National Institute of Child Health and Human Development Intravenous Immunoglobulin Clinical Trial) were analyzed. Disease progression was defined as growth failure, CD4+ lymphocyte percent decline to <15% after study entry or development of an AIDS-defining opportunistic infection. RESULTS Baseline samples were available for ICD p24 antigen testing (median concentration, 319 pg/ml; range, <50 to 15,640) in 240 children. The combination of detectable ICD p24 antigen and low p24 antibody was more sensitive but less specific than the combination of high HIV-1 RNA and low CD4+ lymphocyte percent in predicting disease progression and mortality. Using receiver operating characteristic curves, the specificity of ICD p24 antigen with p24 antibody for classifying children's disease progression or mortality was as great as, or greater than, HIV-1 RNA with CD4+ lymphocyte percent at points on the curve corresponding to higher sensitivity. CONCLUSIONS The use of ICD p24 antigen with p24 antibody to identify children at high risk of disease progression or mortality could be a viable alternative to the more expensive and technically difficult HIV-1 RNA and CD4+ lymphocyte assays in resource-poor settings, including developing countries where the majority of children with HIV-1 infection reside.
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Affiliation(s)
- J S Read
- Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, Bethesda, MD 20892-7510, USA.
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