1
|
Quigley J, Hussain T, Arthur C. False-positive HIV screening test in a healthcare student. Occup Med (Lond) 2024; 74:251-253. [PMID: 38526854 DOI: 10.1093/occmed/kqae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
This case report describes a 22-year-old female Ambulance Technician student who displayed human immunodeficiency virus (HIV) false positivity following a recent hepatitis B vaccination. Occupational health clinicians who work in a healthcare setting (with healthcare staff and/or students) should be aware of the possibility of false-positive HIV screening test results, and where a false positive is suspected, they should consider what the underlying cause could be and should consider whether further medical investigation is required.
Collapse
Affiliation(s)
- J Quigley
- Consultant Occupational Physician, Independent, Manchester, UK
| | - T Hussain
- Consultant Occupational Physician, Independent, Manchester, UK
| | - C Arthur
- Occupational Health Advisor, Optima Health, Manchester, UK
| |
Collapse
|
2
|
Boté-Casamitjana A, Faye-Joof T, Bah O, Jallow S, Camara A, Jallow O, Mohammed N, Forrest K, Nadjm B. Evaluating the sensitivity and specificity of Determine™ HIV-1/2 rapid test using a 0.01M phosphate-buffered saline produced at the Medical Research Council Unit The Gambia for the diagnosis of HIV. Trans R Soc Trop Med Hyg 2024; 118:127-135. [PMID: 37818849 PMCID: PMC10833640 DOI: 10.1093/trstmh/trad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/14/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) rapid diagnostic tests (RDTs) are widely used. However, buffer stockouts commonly lead to utilising non-approved liquids, resulting in errors. Our aim was to evaluate the diagnostic accuracy of an alternative buffer. METHODS Paired Determine HIV-1/2 rapid tests with commercial buffer and locally produced 0.01M phosphate-buffered saline (PBS) were performed on consecutive consenting individuals requiring HIV testing. Serum samples were sent for confirmation through the local gold-standard algorithm (Murex HIV Ag/Ab, Hexagon HIV with/without Geenius HIV 1/2). Test accuracy, κ and exact McNemar's test were also carried out. RESULTS Of 167 participants, 137 had confirmatory testing. The sensitivity of the Determine HIV-1/2 test using PBS compared with the gold standard was 100% (95% confidence interval [CI] 90.5 to 100) with a specificity of 98% (95% CI 92.9 to 99.8). The κ value was 0.94 compared with the gold standard and 0.92 compared with the Determine HIV-1/2 test using the commercial buffer. McNemar's test showed no evidence of differing sensitivities. Due to operational constraints, the study included 37 of the 49 positive cases as determined by the sample size calculation, resulting in an attained power of 80% instead of the intended 90%. CONCLUSIONS These results suggest that 0.01M PBS is an alternative solution for Determine HIV-1/2 when buffer stockouts occur.
Collapse
Affiliation(s)
- Anna Boté-Casamitjana
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Boulevard, The Gambia
| | - Tisbeh Faye-Joof
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Boulevard, The Gambia
| | - Ousman Bah
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Boulevard, The Gambia
| | - Sira Jallow
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Boulevard, The Gambia
| | - Alagie Camara
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Boulevard, The Gambia
| | - Olimatou Jallow
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Boulevard, The Gambia
| | - Nuredin Mohammed
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Boulevard, The Gambia
| | - Karen Forrest
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Boulevard, The Gambia
| | - Behzad Nadjm
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Atlantic Boulevard, The Gambia
| |
Collapse
|
3
|
Lasmanovich R, Atias D, Mor O, Obolski U. False-positive HIV screening tests during the COVID-19 pandemic, a passing trend? AIDS 2023; 37:2430-2432. [PMID: 37965741 DOI: 10.1097/qad.0000000000003693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
False-positive fourth-generation HIV screening tests are rare and are usually associated with various infections and autoimmune diseases. SARS-CoV-2 infection and vaccination were recently linked with false-positive HIV screening test results. However, little is known about false-positives in people who performed HIV screening tests after outbreaks of different SARS-CoV-2 strains and vaccination campaigns. Here, we examined the false-positive rates in samples collected by the Israeli AIDS Task Force in 2018--2022, with respect to such factors.
Collapse
Affiliation(s)
| | - Dor Atias
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Orna Mor
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat-Gan
| | - Uri Obolski
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv
- Porter School of the Environment and Earth Sciences, Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
He JZ, Rezwan M, Arif A, Baroud S, Elhaj M, Khan A. Acute Babesiosis Causing a False-Positive HIV Result: An Unexpected Association. Case Rep Infect Dis 2023; 2023:6271710. [PMID: 37528903 PMCID: PMC10390267 DOI: 10.1155/2023/6271710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/31/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023] Open
Abstract
Babesiosis is a tick-borne condition that causes hemolytic anemia and manifests with flu-like symptoms such as fevers, chills, fatigue, and anorexia. Very few case reports have documented babesiosis infection associated with a false-positive HIV test. In this case report, we add to the current literature by describing a patient admitted for treatment of babesiosis who had a preliminary positive HIV test on admission and a negative repeat HIV test after one week of treatment for babesiosis. A 60-year-old male with a past medical history of high cholesterol presented to the Emergency Department after having abnormal laboratory tests with his primary care doctor. He reported fever, fatigue, anorexia, and worsening jaundice for three weeks. He was hypotensive and febrile on admission. A blood smear showed Babesia species with 1-2% infected red blood cells. He was admitted to the intensive care unit and received treatment with plasmapheresis, atovaquone, and antibiotics. The fourth-generation HIV 1/2 antigen/antibody test was initially positive but after treatment, HIV testing was negative. A misdiagnosis of HIV can greatly impact a patient's quality of life as antiretroviral therapy has multiple deleterious side effects. Clinicians must consider further evaluation of patients with acute babesiosis who also test positive for HIV.
Collapse
Affiliation(s)
- Jody Z. He
- Flushing Hospital Medical Center, 4500 Parsons Blvd Queens, New York, NY 11355, USA
| | - Montasin Rezwan
- Flushing Hospital Medical Center, 4500 Parsons Blvd Queens, New York, NY 11355, USA
| | - Aneela Arif
- Flushing Hospital Medical Center, 4500 Parsons Blvd Queens, New York, NY 11355, USA
| | - Saada Baroud
- Flushing Hospital Medical Center, 4500 Parsons Blvd Queens, New York, NY 11355, USA
| | - Mohamed Elhaj
- Flushing Hospital Medical Center, 4500 Parsons Blvd Queens, New York, NY 11355, USA
| | - Aizaaz Khan
- Flushing Hospital Medical Center, 4500 Parsons Blvd Queens, New York, NY 11355, USA
| |
Collapse
|
5
|
Yadav S, Senapati S, Kulkarni SS, Singh JP. A SERS based clinical study on HIV-1 viral load quantification and determination of disease prognosis. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2023; 239:112629. [PMID: 36577167 DOI: 10.1016/j.jphotobiol.2022.112629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/27/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
In resource limited settings, a cost-effective point-of-care diagnostic testing possessing the characteristics of detecting the minimum viral load of a malady like human immunodeficiency virus (HIV) acquired immune deficiency syndrome (AIDS) is a pressing priority. The present work describes a novel, rapid and field-deployable method using surface enhanced Raman spectroscopy (SERS) for detection and prognosis of HIV positive clinical samples, in seven different viral load ranges varying between 200 and 1 million copies/ml. A relationship between the increasing and decreasing intensity peaks of HIV-1 was also established for quantitation efficacy of the handheld tool. Three different types of SERS substrates: single arm Ag nanorods, double arm Ag nanorods and Au sputtered single arm Ag nanorods were used and the obtained data was compared for the three substrates. It was demonstrated that maximum enhancement was obtained for Au sputtered Ag nanorods. Rigorous coupled wave analysis (RCWA) simulations were performed to study the 'hotspots' in three different SERS substrates. Further, to explore the utility of our platform and to differentiate between the clade specific X4 and R5 tropism, their corresponding SERS spectra were studied using HIV-1 strains belonging to four different HIV-1 subtypes (A, B, C and D) which showed a clear distinction, implying the usefulness of the platform in understanding the disease prognosis. Statistical analysis of the obtained SERS spectra using principal component analysis (PCA) showed good agreement with the experimental results, confirming the ability of SERS platform to quantitate HIV-1 viral load and distinguish HIV-1 strains on the basis of their SERS spectra.
Collapse
Affiliation(s)
- Sarjana Yadav
- Department of Physics, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
| | - Sneha Senapati
- School of Interdisciplinary Research (SIRe), Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India.
| | - Smita S Kulkarni
- Division of Virology, ICMR-National AIDS Research Institute, Bhosari, Pune 413404, India.
| | - J P Singh
- Department of Physics, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India.
| |
Collapse
|
6
|
Mathur P, Srivastava S, Singh P, Malhotra R. False-positive human immunodeficiency virus reactivity in COVID patients: A word of caution. J Glob Infect Dis 2022; 14:43-44. [PMID: 35418733 PMCID: PMC8996452 DOI: 10.4103/jgid.jgid_226_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/04/2022] Open
|
7
|
Woodford J, Sagara I, Kwan J, Zaidi I, Dicko A, Duffy PE. Assessing and Minimizing the Effect of Malaria on SARS-CoV-2 Serodiagnostics. FRONTIERS IN TROPICAL DISEASES 2021. [DOI: 10.3389/fitd.2021.781586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Malaria may affect the reliability of SARS-CoV-2 seroassay performance and limit understanding of SARS-CoV-2 epidemiology in malaria-endemic regions. We present our experience conducting SARS-CoV-2 serosurveillance in seasonal malaria-affected communities in Mali and discuss relevant literature regarding the effect of malaria on the performance of SARS-CoV-2 serodiagnostics, including approaches to minimize the effect of malaria-associated assay interference.
Collapse
|
8
|
Vanroye F, den Bossche DV, Brosius I, Tack B, Esbroeck MV, Jacobs J. COVID-19 Antibody Detecting Rapid Diagnostic Tests Show High Cross-Reactivity When Challenged with Pre-Pandemic Malaria, Schistosomiasis and Dengue Samples. Diagnostics (Basel) 2021; 11:diagnostics11071163. [PMID: 34202195 PMCID: PMC8305106 DOI: 10.3390/diagnostics11071163] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 12/13/2022] Open
Abstract
COVID-19 Antibody Detecting Rapid Diagnostic Tests (COVID-19 Ab RDTs) are the preferred tool for SARS-CoV-2 seroprevalence studies, particularly in low- and middle-income countries. The present study challenged COVID-19 Ab RDTs with pre-pandemic samples of patients exposed to tropical pathogens. A retrospective study was performed on archived serum (n = 94) and EDTA whole blood (n = 126) samples obtained during 2010–2018 from 196 travelers with malaria (n = 170), schistosomiasis (n = 25) and dengue (n = 25). COVID-19 Ab RDTs were selected based on regulatory approval status, independent evaluation results and detecting antigens. Among 13 COVID-19 Ab RDT products, overall cross-reactivity was 18.5%; cross-reactivity for malaria, schistosomiasis and dengue was 20.3%, 18.1% and 7.5%, respectively. Cross-reactivity for current and recent malaria, malaria antibodies, Plasmodium species and parasite densities was similar. Cross-reactivity among the different RDT products ranged from 2.7% to 48.9% (median value 14.5%). IgM represented 67.9% of cross-reactive test lines. Cross-reactivity was not associated with detecting antigens, patient categories or disease (sub)groups, except for schistosomiasis (two products with ≥60% cross-reactivity). The high cross-reactivity for malaria, schistosomiasis and—to a lesser extent—dengue calls for risk mitigation when using COVID-19 Ab RDTs in co-endemic regions.
Collapse
Affiliation(s)
- Fien Vanroye
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (D.V.d.B.); (I.B.); (B.T.); (M.V.E.); (J.J.)
- Correspondence:
| | - Dorien Van den Bossche
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (D.V.d.B.); (I.B.); (B.T.); (M.V.E.); (J.J.)
| | - Isabel Brosius
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (D.V.d.B.); (I.B.); (B.T.); (M.V.E.); (J.J.)
| | - Bieke Tack
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (D.V.d.B.); (I.B.); (B.T.); (M.V.E.); (J.J.)
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (D.V.d.B.); (I.B.); (B.T.); (M.V.E.); (J.J.)
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (D.V.d.B.); (I.B.); (B.T.); (M.V.E.); (J.J.)
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
| |
Collapse
|
9
|
Sagara I, Woodford J, Dicko A, Zeguime A, Doucoure M, Kwan J, Zaidi I, Doritchamou J, Snow-Smith M, Alani N, Renn J, Kosik I, Holly J, Yewdell J, Esposito D, Sadtler K, Duffy P. SARS-CoV-2 seroassay optimization and performance in a population with high background reactivity in Mali. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.03.08.21252784. [PMID: 33758883 PMCID: PMC7987042 DOI: 10.1101/2021.03.08.21252784] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Serological tests are an indispensable tool to understand the epidemiology of the SARS-CoV-2 pandemic, particularly in areas where molecular diagnostics are limited. Poor assay performance may hinder the utility of these tests, including high rates of false-positivity previously reported in sub-Saharan Africa. From 312 Malian samples collected prior to 2020, we measured antibodies to the commonly tested SARS-CoV-2 antigens and four other betacoronaviruses by ELISA, and assessed functional cross-reactivity in a subset by SARS-CoV-2 pseudovirus neutralization assay. We then evaluated the performance of an ELISA developed in the US, using two-antigen SARS-CoV-2 spike protein and receptor-binding domain. To optimize test performance, we compared single and two-antigen approaches using existing assay cutoffs and population-specific cutoffs for Malian control samples (positive and negative). Background reactivity to SARS-CoV-2 antigens was common in pre-pandemic samples compared to US controls (43.4% (135/311) for spike protein, 22.8% (71/312) for RBD, and 33.9% (79/233) for nucleocapsid protein). SARS-CoV-2 reactivity correlated weakly with other betacoronavirus reactivity, varied between Malian communities, and increased with age. No pre-pandemic samples demonstrated functional activity. Regardless of the cutoffs applied, specificity improved using a two-antigen approach. Test performance was optimal using a two-antigen assay with population-specific cutoffs derived from ROC curve analysis [Sensitivity: 73.9% (51.6-89.8), Specificity: 99.4% (97.7-99.9)]. In the setting of high background reactivity, such as sub-Saharan Africa, SARS-CoV-2 serological assays need careful qualification is to characterize the epidemiology of disease, prevent unnecessary harm, and allocate resources for targeted control measures.
Collapse
|
10
|
Ochola J, Imbach M, Eller LA, de Souza M, Nwoga C, Otieno JD, Otieno L, Rono E, Kamau E, Crowell TA, Owuoth JK, Polyak CS, Sing'oei V. False reactive HIV-1 diagnostic test results in an individual from Kenya on multiple testing platforms-A case report. IDCases 2021; 23:e01035. [PMID: 33489756 PMCID: PMC7808907 DOI: 10.1016/j.idcr.2020.e01035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022] Open
Abstract
Background Rapid diagnostic tests (RDT) are routinely used in screening for HIV infection. More complex diagnostic algorithms incorporating fourth-generation screening and confirmatory HIV-1/HIV-2 differentiation immunoassays (IA) may be used to confirm HIV infection. Co-infections and autoimmune diseases may lead to falsely reactive HIV diagnostic test results. Case presentation A Kenyan man with asymptomatic schistosomiasis and low risk factors for HIV infection demonstrated an inconsistent and discordant pattern of reactivity on HIV RDT, repeated reactivity on fourth-generation IA and positive at a single time-point for HIV-1 on the Geenius HIV1/HIV2 confirmatory assay during the course of a prospective cohort study with HIV repeat testing. The individual initiated antiretroviral therapy following HIV diagnosis. However, his bi-annual behavioral questionnaire suggested low-risk factors for infection. Supplementary confirmatory serologic and nucleic acid tests were performed and gave discordant results. The participant was determined to be HIV uninfected using cell-associated HIV-1 DNA/RNA testing and antiretroviral therapy was discontinued. Discussion and conclusions Sole reliance on diagnostic test results may result in misdiagnosis of HIV infection, social harm and potential antiretroviral induced drug toxicity. Interpretation of HIV test results should incorporate multiple parameters.
Collapse
Affiliation(s)
- Jew Ochola
- HJF Medical Research International, Kisumu, Kenya.,U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya
| | - Michelle Imbach
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Leigh Anne Eller
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Mark de Souza
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Chiaka Nwoga
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - June Doryne Otieno
- U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Lucas Otieno
- U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Eric Rono
- U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya.,Kenya Medical Research Institute, Kisumu, Kenya
| | - Edwin Kamau
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - John Kevin Owuoth
- HJF Medical Research International, Kisumu, Kenya.,U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Valentine Sing'oei
- HJF Medical Research International, Kisumu, Kenya.,U.S. Army Medical Research Directorate - Africa, Kisumu, Kenya
| | | |
Collapse
|
11
|
Jacobs J, Kühne V, Lunguya O, Affolabi D, Hardy L, Vandenberg O. Implementing COVID-19 (SARS-CoV-2) Rapid Diagnostic Tests in Sub-Saharan Africa: A Review. Front Med (Lausanne) 2020; 7:557797. [PMID: 33195307 PMCID: PMC7662157 DOI: 10.3389/fmed.2020.557797] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/15/2020] [Indexed: 01/23/2023] Open
Abstract
Introduction: For the COVID-19 (SARS-CoV-2) response, COVID-19 antigen (Ag), and antibody (Ab) rapid diagnostic tests (RDTs) are expected to complement central molecular testing particularly in low-resource settings. The present review assesses requirements for implementation of COVID-19 RDTs in sub-Saharan Africa. Methods: Review of PubMed-published articles assessing COVID-19 RDTs complemented with Instructions for Use (IFU) of products. Results: In total 47 articles on two COVID-19 Ag RDTs and 54 COVID-19 Ab RDTs and IFUs of 20 COVID-19 Ab RDTs were retrieved. Only five COVID-19 Ab RDTs (9.3%) were assessed with capillary blood sampling at the point-of-care; none of the studies were conducted in sub-Saharan Africa. Sampling: Challenges for COVID-19 Ag RDTs include nasopharyngeal sampling (technique, biosafety) and sample stability; for COVID-19 Ab RDTs equivalence of whole blood vs. plasma/serum needs further validation (assessed for only eight (14.8%) products). Sensitivity-Specificity: sensitivity of COVID-19 Ag and Ab RDTs depend on viral load (antigen) and timeframe (antibody), respectively; COVID-19 Ab tests have lower sensitivity compared to laboratory test platforms and the kinetics of IgM and IgG are very similar. Reported specificity was high but has not yet been assessed against tropical pathogens. Kit configuration: For COVID-19 Ag RDTs, flocked swabs should be added to the kit; for COVID-19 Ab RDTs, finger prick sampling materials, transfer devices, and controls should be added (currently only supplied in 15, 5, and 1/20 products). Usability and Robustness: some COVID-19 Ab RDTs showed high proportions of faint lines (>40%) or invalid results (>20%). Shortcomings were reported for buffer vials (spills, air bubbles) and their instructions for use. Stability: storage temperature was ≤ 30°C for all but one RDT, in-use and result stability were maximal at 1 h and 30 min, respectively. Integration in the healthcare setting requires a target product profile, landscape overview of technologies, certified manufacturing capacity, a sustainable market, and a stringent but timely regulation. In-country deployment depends on integration in the national laboratory network. Discussion/Conclusion: Despite these limitations, successful implementation models in triage, contact tracing, and surveillance have been proposed, in particular for COVID-19 Ab RDTs. Valuable experience is available from implementation of other disease-specific RDTs in sub-Saharan Africa.
Collapse
Affiliation(s)
- Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Vera Kühne
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Octavie Lunguya
- Department of Clinical Microbiology, National Institute of Biomedical Research, Kinshasa, Democratic Republic of Congo
- Microbiology Unit, Department of Clinical Biology, University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Dissou Affolabi
- Clinical Microbiology, Centre National Hospitalier et Universitaire Hubert Koutoukou MAGA, Cotonou, Benin
| | - Liselotte Hardy
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Olivier Vandenberg
- Center for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Innovation and Business Development Unit, Laboratoire Hospitalier Universitaire de Bruxelles - Universitair Laboratorium Brussel (LHUB-ULB), ULB, Brussels, Belgium
- Division of Infection and Immunity, Faculty of Medical Sciences, University College London, London, United Kingdom
| |
Collapse
|
12
|
Al-Kindi H, Al-Jardani A. HIV serology false positivity among expatriates from Africa: a screening dilemma. J Med Microbiol 2020; 69:812-816. [PMID: 32469303 PMCID: PMC7451036 DOI: 10.1099/jmm.0.001186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
HIV prevalence in Oman is low (<5 %); however, 45 % of the population are expatriates, including a portion originating from countries with high HIV prevalence (>5 %). HIV screening is performed at regional public health laboratories as part of a medical fitness programme for residency applicants. We conducted a retrospective evaluation of indeterminate serology results from 11 females of African origin, aged 21–43 years. Serology testing for HIV was conducted according to the national Oman algorithm: fourth-generation immunoassays (Bio-Rad GS HIV Combo Ag/Ab EIA, Siemens Enzygnost HIV Integral 4, Abbott ARCHITECT HIV Ag/Ab Combo, Roche Elecsys HIV Combi PT, bioMérieux VIDAS HIV DUO QUICK), confirmatory assays (Geenius HIV 1/2 Confirmatory, INNO-LIA HIV I/II Score) and PCR testing. Confirmatory testing to resolve indeterminate results was conducted with available samples for five patients using a combination of immunoassays, confirmatory assays, PCR/PERT and pro-viral DNA levels, at three external laboratories; Roche Diagnostics (Germany), Swiss National Laboratory (Switzerland) and Barts Health NHS Trust (UK). Nineteen serum, 15 plasma and two whole-blood samples were analysed. Nine of ten patients analysed on Bio-Rad and Siemens immunoassays were highly reactive; seven were highly reactive on the Abbott assay. Eight of nine patients tested with the Roche assay were negative. Three of four patients tested on the bioMérieux assay were negative. Five patients underwent confirmatory testing at external laboratories; all were negative by HIV-RNA or pro-viral DNA testing. In conclusion, HIV-RNA and pro-viral DNA testing is recommended for HIV screening of individuals from high-prevalence regions coming to low-prevalence regions.
Collapse
Affiliation(s)
- Hanan Al-Kindi
- Central Public Health Laboratories, Ministry of Health, Muscat, Oman
| | - Amina Al-Jardani
- Central Public Health Laboratories, Ministry of Health, Muscat, Oman
| |
Collapse
|
13
|
High positive HIV serology results can still be false positive. IDCases 2020; 21:e00849. [PMID: 32514397 PMCID: PMC7267741 DOI: 10.1016/j.idcr.2020.e00849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/23/2020] [Accepted: 05/23/2020] [Indexed: 11/08/2022] Open
Abstract
The consequences of falsely reactive HIV test results can be significant, for patients and healthcare providers. This case describes a diagnostic investigation of a patient with pronounced discordant HIV serological results, to determine HIV status. The fourth generation serological screening assay (Roche COBAS Elecsys HIV combiPT) had high positive results but confirmatory testing was negative (Abbott HIV Ag/Ab Combo). Five separate samples over 13 days were tested using multiple fourth generation HIV immunoassays and molecular tests for HIV-1 and HIV-2. Potential causes of falsely reactive serological results were investigated. Samples were sent to the manufacturer for analysis. The screening assay was positive on all samples with a very high signal to cut-off ratio (S/CO) of greater than 400. However, multiple serological and molecular assays did not detect HIV-1 or HIV-2 specific antibodies, antigen or nucleic acid. A recombinant immunochromatographic assay had faint reactivity to gp41 peptide and the manufacturer investigation reported cross-reactivity to one of the screening assay’s synthetic peptides. Possible causes of the false positive result include cross reactivity to other antigens, including prior schistosomiasis infection, or the patient’s previously excised ameloblastoma (a rare germ cell tumor of the jaw). This is a rare case of false high positive results on fourth-generation HIV serology testing due to high level non-specific reactivity to an isolated synthetic peptide component of the assay. It highlights the need for confirmatory testing even in settings with HIV high prevalence and awareness that false-positive serological results may have a high S/CO.
Collapse
|
14
|
Tagny CT, Bissim M, Djeumen R, Ngo Sack F, Angandji P, Ndoumba A, Kouanfack C, Eno L, Mbanya D, Murphy EL, Laperche S. The use of the Geenius TM HIV-1/2 Rapid confirmatory test for the enrolment of patients and blood donors in the WHO Universal Test and Treat Strategy in Cameroon, Africa. Vox Sang 2020; 115:686-694. [PMID: 32468573 DOI: 10.1111/vox.12942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE In the WHO Universal test and treat strategy, false-positive HIV blood donors and patients may be unnecessarily put under antiretroviral treatment and false-negative subjects may be lost to follow-up. This study assessed the false positivity rate of the Cameroonian national HIV screening testing algorithm and the benefit of a confirmation test in the enrolment of patients and donors in the HIV care programme. METHODS We included initial HIV reactive blood donors and patients in a cross-sectional study conducted in two Cameroonian hospitals. Samples were retested according to the Cameroon national algorithm for HIV diagnosis. A positive or discordant sample was retested with the Geenius Bio-Rad HIV 1&2 (Bio-Rad, Marnes-la-Coquette, France) for confirmation. The Geenius HIV-1-positive results with 'poor' profiles were retested for RNA as well as the Geenius indeterminate results. RESULTS Of the 356 participants, 190/225 (84·4%) patients and 76/131 (58%) blood donors were declared positive with the national algorithm; 257 participants (96·6%) were confirmed HIV-1-positive. The study revealed that about 34/1000 blood donors and patients are false-positive and unnecessarily put on treatment; 89/1000 blood donors and patients declared discordant could have been included immediately in the HIV care programme if confirmatory testing was performed. The second test of the algorithm had a false-negative rate of 3%. Eleven samples (3·1%) were Geenius poor positive and NAT negative. CONCLUSION The universal test and treat strategy may identify and refer more individuals to HIV care if a third rapid confirmatory test is performed for discordant cases.
Collapse
Affiliation(s)
- Claude T Tagny
- Hematology and Blood Transfusion Service, Yaoundé University Hospital, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, UY1, Yaoundé, Cameroon
| | - Marie Bissim
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Rolande Djeumen
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | | | | | - Annick Ndoumba
- Faculty of Medicine and Biomedical Sciences, UY1, Yaoundé, Cameroon.,School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | | | - Laura Eno
- The US Center for Diseases' Control, Yaoundé, Cameroon
| | - Dora Mbanya
- Hematology and Blood Transfusion Service, Yaoundé University Hospital, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, UY1, Yaoundé, Cameroon
| | | | | |
Collapse
|
15
|
Demir T, Yalcin S, Kilic S. Evaluation of the diagnostic performance and optimal cutoff value of a fourth-generation ELISA, VIDAS HIV-1/2 Duo Ultra assay, in a low-prevalence country. Diagn Microbiol Infect Dis 2020; 97:115011. [PMID: 32139113 DOI: 10.1016/j.diagmicrobio.2020.115011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 12/07/2019] [Accepted: 01/27/2020] [Indexed: 11/25/2022]
Abstract
In this study, we described the largest analysis to date conducted with VIDAS® HIV Duo Ultra assay. Additionally, we analyzed the diagnostic performance and cutoff values (TV) of HIV Duo Ultra assay and total cost analysis for HIV testing. Of 11,642 enzyme-linked immunosorbent assay (ELISA)-positive samples referred to our center for confirmation, 2000 were positive with HIV Duo Ultra, and of these, 87% were HIV-1 positive and 0.6% were HIV-1 indeterminate with the confirmatory test. Overall, the false-positivity rate was 1.75% for HIV Duo Ultra assay. The sensitivity and specificity were 100% and 99.1%, respectively, when the TV was set at the recommended cutoff value. Even increasing the cutoff value four times, sensitivity and specificity remained high, pointing out that a TV of 0.99 is highly indicative of HIV positivity. Retesting samples with HIV Duo Ultra assay decreased 80% of the confirmatory tests, revealing a significant decrease of 78% in the total costs and reporting time.
Collapse
Affiliation(s)
- Tulin Demir
- Ministry of Health, Public Health Institute, National Reference Laboratory for HIV/AIDS and Viral Hepatitis Department, Ankara, Turkey.
| | - Suleyman Yalcin
- Ministry of Health, Public Health Institute, National Reference Laboratory for HIV/AIDS and Viral Hepatitis Department, Ankara, Turkey
| | - Selcuk Kilic
- Ministry of Health, Public Health Institute, National Reference Laboratory for HIV/AIDS and Viral Hepatitis Department, Ankara, Turkey; University of Health Sciences, Istanbul Medical Faculty, Department of Medical Microbiology, İstanbul, Turkey
| |
Collapse
|
16
|
Repeated false reactive ADVIA centaur® and bio-rad Geenius™ HIV tests in a patient self-administering anabolic steroids. BMC Infect Dis 2020; 20:9. [PMID: 31906866 PMCID: PMC6945705 DOI: 10.1186/s12879-019-4722-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/22/2019] [Indexed: 11/25/2022] Open
Abstract
Background An individual is considered HIV positive when a confirmatory HIV-1/HIV-2 differentiation test returns positive following an initial reactive antigen/antibody combination screen. Falsely reactive HIV screens have been reported in patients with various concomitant infectious and autoimmune conditions. Falsely positive confirmatory HIV differentiation assays are seen less frequently, but have been observed in cases of pregnancy, pulmonary embolism, and malaria. Case presentation A healthy 27 year-old man was referred after a reactive ADVIA Centaur® HIV Ag/Ab screen and positive Bio-Rad Geenius™ HIV 1/2 Confirmatory assay, suggesting HIV-1 infection. The patient’s HIV viral load was undetectable prior to initiation of antiretroviral therapy, and remained undetectable on subsequent testing after initiation of antiretroviral therapy. Both Centaur® and Geenius™ tests were repeated and returned reactive. As this patient was believed to be at low risk of acquiring HIV infection, samples were additionally run on Genscreen™ HIV-1 Ag assay and Fujirebio Inno-LIA™ HIV-1/2 score, with both returning non-reactive. For confirmation, the patient’s proviral HIV DNA testing was negative, confirming the initial results as being falsely positive. The patient disclosed that he had been using a variety of anabolic steroids before and during the time of HIV testing. Discussion and conclusions The erroneous diagnosis of HIV can result in decreased quality of life and adverse effects of antiretroviral therapy if initiated, hence the importance of interpreting the results of HIV testing in the context of an individual patient. This reports suggests a potential association between the use of anabolic steroids and falsely-reactive HIV testing.
Collapse
|
17
|
Robinson MA, Nagurla SR, Noblitt TR, Almaghlouth NK, Al-rahamneh MM, Cashin LM. Falsely positive fourth generation ADVIA Centaur® HIV Antigen/Antibody Combo assay in the presence of autoimmune hepatitis type I (AIH). IDCases 2020; 21:e00886. [PMID: 32642434 PMCID: PMC7334457 DOI: 10.1016/j.idcr.2020.e00886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 10/27/2022] Open
|
18
|
Candotti D, Sauvage V, Cappy P, Boullahi MA, Bizimana P, Mbensa GO, Oumar Coulibaly S, Rakoto Alson AO, Soumana H, Tagny-Tayou C, Murphy EL, Laperche S. High rate of hepatitis C virus and human immunodeficiency virus false-positive results in serologic screening in sub-Saharan Africa: adverse impact on the blood supply. Transfusion 2019; 60:106-116. [PMID: 31777096 DOI: 10.1111/trf.15593] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND False positivity in blood screening may cause unnecessary deferral of healthy donors and exacerbate blood shortages. An international multicenter study was conducted to estimate the frequency of HCV and HIV false seropositivity in seven African countries (Burundi, Cameroon, Democratic Republic of Congo, Madagascar, Mali, Mauritania, and Niger). STUDY DESIGN AND METHODS Blood donations were tested for hepatitis C virus (HCV) and human immunodeficiency virus (HIV) with rapid detection tests (RDTs), third-generation enzyme immunoassays (EIAs), or fourth-generation EIAs. HCV (456/16,613 [2.74%]) and HIV (249/16,675 [1.49%]) reactive samples were then confirmed with antigen/antibody assays, immunoblots, and nucleic acid testing. Partial viral sequences were analyzed when possible. RESULTS The HCV reactivity rate with RDTs was significantly lower than with EIAs (0.55% vs. 3.52%; p < 0.0001). The HIV reactivity rate with RDTs was lower than with third-generation EIAs (1.02% vs. 2.38%; p < 0.0001) but similar to a fourth-generation assay (1.09%). Only 16.0% (57/357) and 21.5% (38/177) of HCV and HIV initial reactive samples, respectively, were repeatedly reactive. HCV and HIV infections were confirmed in 13.2% and 13.7%, respectively, of repeated reactive donations. The predominant HCV genotype 2 and 4 strains in West and Central Africa showed high genetic variability. HIV-1 subtype CRF02_AG was most prevalent. CONCLUSION High rates (>80%) of unconfirmed anti-HCV and anti-HIV reactivity observed in several sub-Saharan countries highlights the need for better testing and confirmatory strategies for donors screening in Africa. Without confirmatory testing, HCV and HIV prevalence in African blood donors has probably been overestimated.
Collapse
Affiliation(s)
- Daniel Candotti
- National Institute of Blood Transfusion/INTS, National Reference Center for Infectious Risk in Transfusion, Department of Blood-borne Agents, Paris, France
| | - Virginie Sauvage
- National Institute of Blood Transfusion/INTS, National Reference Center for Infectious Risk in Transfusion, Department of Blood-borne Agents, Paris, France
| | - Pierre Cappy
- National Institute of Blood Transfusion/INTS, National Reference Center for Infectious Risk in Transfusion, Department of Blood-borne Agents, Paris, France
| | | | | | | | | | | | | | - Claude Tagny-Tayou
- Department of Hematology, Faculty of Medicine and Biomedical Sciences of University of Yaoundé I, Yaoundé, Cameroon
| | - Edward L Murphy
- Departments of Laboratory Medicine and Epidemiology/Biostatistics, University of California, San Francisco, San Francisco, California.,Vitalant Research Institute, San Francisco, California
| | - Syria Laperche
- National Institute of Blood Transfusion/INTS, National Reference Center for Infectious Risk in Transfusion, Department of Blood-borne Agents, Paris, France
| | | |
Collapse
|
19
|
Sánchez-Pardo S, Osorio-Ramírez JA, Choi-Park I, Rojas-Holguín DF, Bolívar-Mejía A. False-positive fourth-generation HIV test associated with autoimmune hemolytic anemia. Case report. CASE REPORTS 2019. [DOI: 10.15446/cr.v5n2.78532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: The fourth-generation ELISA human immunodeficiency virus (HIV) screening test has a high sensitivity and specificity >99% to detect both antigens and antibodies. Estimates are that only 0.5% yield false positive results.Case description: 61-year-old female patient with a clinical picture consisting of malaise, unquantified fever, asthenia and adynamia. Laboratory tests revealed anemia, so a Coombs test was performed, obtaining a positive result along with other findings of mixed autoimmune hemolytic anemia. Two fourth-generation ELISA HIV screening tests were performed obtaining positive results. Given the national recommendations on the diagnosis of HIV infection, a viral load was performed, which turned out to be negative, so the result was considered a false positive.Discussion: Clinical and biological factors are related to false positive results. There are descriptions about autoimmunity phenomena, such as systemic lupus erythematosus or autoimmune hemolytic anemia, with few cases in older adults.Conclusions: Rapid tests have changed the diagnosis of HIV infection worldwide; however, like any other diagnostic test, they may yield false positive results with differential diagnoses, including autoimmune hemolytic anemia.
Collapse
|
20
|
Zyl G, Maritz J, Newman H, Preiser W. Lessons in diagnostic virology: expected and unexpected sources of error. Rev Med Virol 2019; 29:e2052. [DOI: 10.1002/rmv.2052] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/05/2019] [Accepted: 04/14/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Gert Zyl
- Division of Medical Virology, Department PathologyStellenbosch University, Faculty of Medicine and Health Sciences Parow South Africa
- National Health Laboratory Service South Africa
| | - Jean Maritz
- Division of Medical Virology, Department PathologyStellenbosch University, Faculty of Medicine and Health Sciences Parow South Africa
- PathCare Reference Laboratory Cape Town South Africa
| | - Howard Newman
- Division of Medical Virology, Department PathologyStellenbosch University, Faculty of Medicine and Health Sciences Parow South Africa
- National Health Laboratory Service South Africa
| | - Wolfgang Preiser
- Division of Medical Virology, Department PathologyStellenbosch University, Faculty of Medicine and Health Sciences Parow South Africa
- National Health Laboratory Service South Africa
| |
Collapse
|
21
|
Stempel JM, Mora Carpio AL, Puga D, Perloff S. False positive fourth generation HIV test in a patient with severe malaria. Int J Infect Dis 2019; 83:86-87. [PMID: 30986542 DOI: 10.1016/j.ijid.2019.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022] Open
Abstract
Severe malaria is an uncommon diagnosis in the United States. However, awareness of signs, symptoms, and treatment options is imperative in order to promptly initiate optimal therapy. False positive human immunodeficiency virus (HIV) results are rare in the setting of acute malaria infection and with the introduction of newer fourth-generation immunoassays. The Centers for Disease Control algorithms assist in confirming true HIV infection (Branson et al. 2014).
Collapse
Affiliation(s)
- Jessica M Stempel
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA, 19141, United States.
| | - Andres L Mora Carpio
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA, 19141, United States
| | - Daniel Puga
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA, 19141, United States
| | - Sarah Perloff
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA, 19141, United States; Department of Infectious Diseases, Albert Einstein Medical Center, Philadelphia, PA, 19141, United States
| |
Collapse
|
22
|
Alert, but not alarmed - a comment on "Towards more accurate HIV testing in sub-Saharan Africa: a multi-site evaluation of HIV RDTs and risk factors for false positives (Kosack et al. 2017)". J Int AIDS Soc 2018; 20:22042. [PMID: 28664683 PMCID: PMC5515062 DOI: 10.7448/ias.20.1.22042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
23
|
Towards more accurate HIV testing in sub-Saharan Africa: a multi-site evaluation of HIV RDTs and risk factors for false positives. J Int AIDS Soc 2017; 19:21345. [PMID: 28364560 PMCID: PMC5467586 DOI: 10.7448/ias.20.1.21345] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Although individual HIV rapid diagnostic tests (RDTs) show good performance in evaluations conducted by WHO, reports from several African countries highlight potentially significant performance issues. Despite widespread use of RDTs for HIV diagnosis in resource-constrained settings, there has been no systematic, head-to-head evaluation of their accuracy with specimens from diverse settings across sub-Saharan Africa. We conducted a standardized, centralized evaluation of eight HIV RDTs and two simple confirmatory assays at a WHO collaborating centre for evaluation of HIV diagnostics using specimens from six sites in five sub-Saharan African countries. Methods: Specimens were transported to the Institute of Tropical Medicine (ITM), Antwerp, Belgium for testing. The tests were evaluated by comparing their results to a state-of-the-art reference algorithm to estimate sensitivity, specificity and predictive values. Results: 2785 samples collected from August 2011 to January 2015 were tested at ITM. All RDTs showed very high sensitivity, from 98.8% for First Response HIV Card Test 1–2.0 to 100% for Determine HIV 1/2, Genie Fast, SD Bioline HIV 1/2 3.0 and INSTI HIV-1/HIV-2 Antibody Test kit. Specificity ranged from 90.4% for First Response to 99.7% for HIV 1/2 STAT-PAK with wide variation based on the geographical origin of specimens. Multivariate analysis showed several factors were associated with false-positive results, including gender, provider-initiated testing and the geographical origin of specimens. For simple confirmatory assays, the total sensitivity and specificity was 100% and 98.8% for ImmunoComb II HIV 12 CombFirm (ImmunoComb) and 99.7% and 98.4% for Geenius HIV 1/2 with indeterminate rates of 8.9% and 9.4%. Conclusions: In this first systematic head-to-head evaluation of the most widely used RDTs, individual RDTs performed more poorly than in the WHO evaluations: only one test met the recommended thresholds for RDTs of ≥99% sensitivity and ≥98% specificity. By performing all tests in a centralized setting, we show that these differences in performance cannot be attributed to study procedure, end-user variation, storage conditions, or other methodological factors. These results highlight the existence of geographical and population differences in individual HIV RDT performance and underscore the challenges of designing locally validated algorithms that meet the latest WHO-recommended thresholds.
Collapse
|
24
|
A public health approach to addressing and preventing misdiagnosis in the scale-up of HIV rapid testing programmes. J Int AIDS Soc 2017. [DOI: 10.7448/ias.20.7.22290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
25
|
Johnson CC, Fonner V, Sands A, Ford N, Obermeyer CM, Tsui S, Wong V, Baggaley R. To err is human, to correct is public health: a systematic review examining poor quality testing and misdiagnosis of HIV status. J Int AIDS Soc 2017; 20:21755. [PMID: 28872271 PMCID: PMC5625583 DOI: 10.7448/ias.20.7.21755] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/07/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION In accordance with global testing and treatment targets, many countries are seeking ways to reach the "90-90-90" goals, starting with diagnosing 90% of all people with HIV. Quality HIV testing services are needed to enable people with HIV to be diagnosed and linked to treatment as early as possible. It is essential that opportunities to reach people with undiagnosed HIV are not missed, diagnoses are correct and HIV-negative individuals are not inadvertently initiated on life-long treatment. We conducted this systematic review to assess the magnitude of misdiagnosis and to describe poor HIV testing practices using rapid diagnostic tests. METHODS We systematically searched peer-reviewed articles, abstracts and grey literature published from 1 January 1990 to 19 April 2017. Studies were included if they used at least two rapid diagnostic tests and reported on HIV misdiagnosis, factors related to potential misdiagnosis or described quality issues and errors related to HIV testing. RESULTS Sixty-four studies were included in this review. A small proportion of false positive (median 3.1%, interquartile range (IQR): 0.4-5.2%) and false negative (median: 0.4%, IQR: 0-3.9%) diagnoses were identified. Suboptimal testing strategies were the most common factor in studies reporting misdiagnoses, particularly false positive diagnoses due to using a "tiebreaker" test to resolve discrepant test results. A substantial proportion of false negative diagnoses were related to retesting among people on antiretroviral therapy. Conclusions HIV testing errors and poor practices, particularly those resulting in false positive or false negative diagnoses, do occur but are preventable. Efforts to accelerate HIV diagnosis and linkage to treatment should be complemented by efforts to improve the quality of HIV testing services and strengthen the quality management systems, particularly the use of validated testing algorithms and strategies, retesting people diagnosed with HIV before initiating treatment and providing clear messages to people with HIV on treatment on the risk of a "false negative" test result.
Collapse
Affiliation(s)
- Cheryl C. Johnson
- Department of HIV, World Health Organization, Geneva, Switzerland
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Virginia Fonner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Anita Sands
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Nathan Ford
- Department of HIV, World Health Organization, Geneva, Switzerland
| | - Carla Mahklouf Obermeyer
- Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Sharon Tsui
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vincent Wong
- US Agency for International Development, Washington, DC, USA
| | - Rachel Baggaley
- Department of HIV, World Health Organization, Geneva, Switzerland
| |
Collapse
|
26
|
Harbertson J, Hale BR, Tran BR, Thomas AG, Grillo MP, Jacobs MB, McAnany J, Shaffer RA. Self-reported HIV-positive status but subsequent HIV-negative test result using rapid diagnostic testing algorithms among seven sub-Saharan African military populations. PLoS One 2017; 12:e0180796. [PMID: 28686678 PMCID: PMC5501598 DOI: 10.1371/journal.pone.0180796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 06/21/2017] [Indexed: 11/19/2022] Open
Abstract
HIV rapid diagnostic tests (RDTs) combined in an algorithm are the current standard for HIV diagnosis in many sub-Saharan African countries, and extensive laboratory testing has confirmed HIV RDTs have excellent sensitivity and specificity. However, false-positive RDT algorithm results have been reported due to a variety of factors, such as suboptimal quality assurance procedures and inaccurate interpretation of results. We conducted HIV serosurveys in seven sub-Saharan African military populations and recorded the frequency of personnel self-reporting HIV positivity, but subsequently testing HIV-negative during the serosurvey. The frequency of individuals who reported they were HIV-positive but subsequently tested HIV-negative using RDT algorithms ranged from 3.3 to 91.1%, suggesting significant rates of prior false-positive HIV RDT algorithm results, which should be confirmed using biological testing across time in future studies. Simple measures could substantially reduce false-positive results, such as greater adherence to quality assurance guidelines and prevalence-specific HIV testing algorithms as described in the World Health Organization’s HIV testing guidelines. Other measures to improve RDT algorithm specificity include classifying individuals with weakly positive test lines as HIV indeterminate and retesting. While expansion of HIV testing in resource-limited countries is critical to identifying HIV-infected individuals for appropriate care and treatment, careful attention to potential causes of false HIV-positive results are needed to prevent the significant medical, psychological, and fiscal costs resulting from individuals receiving a false-positive HIV diagnosis.
Collapse
Affiliation(s)
- Judith Harbertson
- Department of Defense HIV/AIDS Prevention Program, Naval Health Research Center, San Diego, California, United States of America
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Leidos, Inc., Reston, Virginia, United States of America
- * E-mail:
| | - Braden R. Hale
- Department of Defense HIV/AIDS Prevention Program, Naval Health Research Center, San Diego, California, United States of America
- University of California, San Diego, La Jolla, California, United States of America
| | - Bonnie R. Tran
- Department of Defense HIV/AIDS Prevention Program, Naval Health Research Center, San Diego, California, United States of America
- Leidos, Inc., Reston, Virginia, United States of America
| | - Anne G. Thomas
- Department of Defense HIV/AIDS Prevention Program, Naval Health Research Center, San Diego, California, United States of America
- Leidos, Inc., Reston, Virginia, United States of America
| | - Michael P. Grillo
- Department of Defense HIV/AIDS Prevention Program, Naval Health Research Center, San Diego, California, United States of America
| | - Marni B. Jacobs
- Department of Defense HIV/AIDS Prevention Program, Naval Health Research Center, San Diego, California, United States of America
- Leidos, Inc., Reston, Virginia, United States of America
| | - Jennifer McAnany
- Department of Defense HIV/AIDS Prevention Program, Naval Health Research Center, San Diego, California, United States of America
- Leidos, Inc., Reston, Virginia, United States of America
| | - Richard A. Shaffer
- Department of Defense HIV/AIDS Prevention Program, Naval Health Research Center, San Diego, California, United States of America
| |
Collapse
|
27
|
A preface on advances in diagnostics for infectious and parasitic diseases: detecting parasites of medical and veterinary importance. Parasitology 2017; 141:1781-8. [PMID: 25415359 DOI: 10.1017/s0031182014001309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
There are many reasons why detection of parasites of medical and veterinary importance is vital and where novel diagnostic and surveillance tools are required. From a medical perspective alone, these originate from a desire for better clinical management and rational use of medications. Diagnosis can be at the individual-level, at close to patient settings in testing a clinical suspicion or at the community-level, perhaps in front of a computer screen, in classification of endemic areas and devising appropriate control interventions. Thus diagnostics for parasitic diseases has a broad remit as parasites are not only tied with their definitive hosts but also in some cases with their vectors/intermediate hosts. Application of current diagnostic tools and decision algorithms in sustaining control programmes, or in elimination settings, can be problematic and even ill-fitting. For example in resource-limited settings, are current diagnostic tools sufficiently robust for operational use at scale or are they confounded by on-the-ground realities; are the diagnostic algorithms underlying public health interventions always understood and well-received within communities which are targeted for control? Within this Special Issue (SI) covering a variety of diseases and diagnostic settings some answers are forthcoming. An important theme, however, throughout the SI is to acknowledge that cross-talk and continuous feedback between development and application of diagnostic tests is crucial if they are to be used effectively and appropriately.
Collapse
|
28
|
Yoonuan T, Nuamtanong S, Dekumyoy P, Phuphisut O, Adisakwattana P. Molecular and immunological characterization of cathepsin L-like cysteine protease of Paragonimus pseudoheterotremus. Parasitol Res 2016; 115:4457-4470. [PMID: 27562899 DOI: 10.1007/s00436-016-5232-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/12/2016] [Indexed: 11/29/2022]
Abstract
Cathepsin L is a cysteine protease belonging to the papain family. In parasitic trematodes, cathepsin L plays essential roles in parasite survival and host-parasite interactions. In this study, cathepsin L of the lung fluke Paragonimus pseudoheterotremus (PpsCatL) was identified and its molecular biological and immunological features characterized. A sequence analysis of PpsCatL showed that the gene encodes a 325-amino-acid protein that is most similar to P. westermani cathepsin L. The in silico three-dimensional structure suggests that PpsCatL is a pro-enzyme that becomes active when the propeptide is cleaved. A recombinant pro-PpsCatL lacking the signal peptide (rPpsCatL), with a molecular weight of 35 kDa, was expressed in E. coli and reacted with P. pseudoheterotremus-infected rat sera. The native protein was detected in crude worm antigens and excretory-secretory products and was localized in the cecum and in the lamellae along the intestinal tract of the adult parasite. Enzymatic activity of rPpsCatL showed that the protein could cleave the fluorogenic substrate Z-Phe-Arg-AMC after autocatalysis but was inhibited with E64. The immunodiagnostic potential of the recombinant protein was evaluated with an enzyme-linked immunosorbent assay (ELISA) and suggested that rPpsCatL can detect paragonimiasis with high sensitivity and specificity (100 and 95.6 %, respectively). This supports the further development of an rPpsCatL-ELISA as an immunodiagnostic tool.
Collapse
Affiliation(s)
- Tippayarat Yoonuan
- Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, 10400, Thailand
| | - Supaporn Nuamtanong
- Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, 10400, Thailand
| | - Paron Dekumyoy
- Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, 10400, Thailand
| | - Orawan Phuphisut
- Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, 10400, Thailand
| | - Poom Adisakwattana
- Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, 10400, Thailand.
| |
Collapse
|
29
|
Liu P, Jackson P, Shaw N, Heysell S. Spectrum of false positivity for the fourth generation human immunodeficiency virus diagnostic tests. AIDS Res Ther 2016; 13:1. [PMID: 26734067 PMCID: PMC4700595 DOI: 10.1186/s12981-015-0086-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 12/22/2015] [Indexed: 01/06/2023] Open
Abstract
Novel fourth generation screening and confirmatory human immunodeficiency virus (HIV) assays are now commercially available and incorporated into new diagnostic algorithms. We report two cases involving a total of three patients which highlight the spectrum of false positivity for both the Abbott Architect p24 antigen/antibody assay and the confirmatory Multispot antibody differentiation test. We then discuss the mechanisms for false positivity and the associated clinical conditions or laboratory scenarios that may predispose to inaccurate interpretation.
Collapse
|
30
|
Andonov A, Songok E, Ochwoto M, Osiowy C, Ball TB. HIV and hepatitis C virus co-infection in Kenya. THE LANCET. INFECTIOUS DISEASES 2015; 15:1377-8. [PMID: 26607120 DOI: 10.1016/s1473-3099(15)00403-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Anton Andonov
- Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, MB, R3E 3R2, Canada.
| | | | | | - Carla Osiowy
- Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, MB, R3E 3R2, Canada
| | - T Blake Ball
- Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, MB, R3E 3R2, Canada
| |
Collapse
|
31
|
Determination of HIV Status in African Adults With Discordant HIV Rapid Tests. J Acquir Immune Defic Syndr 2015; 69:430-8. [PMID: 25835607 DOI: 10.1097/qai.0000000000000610] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In resource-limited settings, HIV infection is often diagnosed using 2 rapid tests. If the results are discordant, a third tie-breaker test is often used to determine HIV status. This study characterized samples with discordant rapid tests and compared different testing strategies for determining HIV status in these cases. METHODS Samples were previously collected from 173 African adults in a population-based survey who had discordant rapid test results. Samples were classified as HIV positive or HIV negative using a rigorous testing algorithm that included two fourth-generation tests, a discriminatory test, and 2 HIV RNA tests. Tie-breaker tests were evaluated, including rapid tests (1 performed in-country), a third-generation enzyme immunoassay, and two fourth-generation tests. Selected samples were further characterized using additional assays. RESULTS Twenty-nine samples (16.8%) were classified as HIV positive and 24 of those samples (82.8%) had undetectable HIV RNA. Antiretroviral drugs were detected in 1 sample. Sensitivity was 8.3%-43% for the rapid tests; 24.1% for the third-generation enzyme immunoassay; 95.8% and 96.6% for the fourth-generation tests. Specificity was lower for the fourth-generation tests than the other tests. Accuracy ranged from 79.5% to 91.3%. CONCLUSIONS In this population-based survey, most HIV-infected adults with discordant rapid tests were virally suppressed without antiretroviral drugs. Use of individual assays as tie-breaker tests was not a reliable method for determining HIV status in these individuals. More extensive testing algorithms that use a fourth-generation screening test with a discriminatory test and HIV RNA test are preferable for determining HIV status in these cases.
Collapse
|
32
|
McNerney R. Diagnostics for Developing Countries. Diagnostics (Basel) 2015; 5:200-9. [PMID: 26854149 PMCID: PMC4665590 DOI: 10.3390/diagnostics5020200] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/07/2015] [Accepted: 05/12/2015] [Indexed: 12/14/2022] Open
Abstract
Improving the availability of high quality diagnostic tests for infectious diseases is a global priority. Lack of access by people living in low income countries may deprive them of life saving treatment and reduces opportunities to prevent onward transmission and spread of the disease. Diagnostic laboratories are often poorly resourced in developing countries, and sparsely distributed. Improved access may be achieved by using tests that do not require laboratory support, including rapid tests for use at the point-of-care. Despite increased interest, few new in vitro diagnostic (IVD) products reach the majority populations in low income countries. Barriers to uptake include cost and lack of robustness, with reduced test performances due to environmental pressures such as high ambient temperatures or dust. In addition to environmental factors test developers must consider the local epidemiology. Confounding conditions such as immunosuppression or variations in antigen presentation or genotype can affect test performance. Barriers to product development include access to finance to establish manufacturing capacity and cover the costs of market entry for new devices. Costs and delays may be inflated by current regulatory preregistration processes to ensure product safety and quality, and more harmonized approaches are needed.
Collapse
Affiliation(s)
- Ruth McNerney
- TB Alert, Community Base, 113 Queens Road, Brighton, BN1 3XG, UK.
| |
Collapse
|
33
|
Paranthaman V, Yip HL, Ker HB. A case study of human immunodeficiency virus with positive seroconversion to negative. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2015; 10:44-6. [PMID: 26425294 PMCID: PMC4567892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This case study demonstrates a 36-year-old ex-intravenous drug user (IVDU) who had been initially tested positive for human immunodeficiency virus (HIV) twice using Enzyme Immunoassay (EIA) method (Particle agglutination, PA done), but a year later he was tested HIV-negative. The patient was asymptomatic for HIV and T helper cells (CD4) count remained stable throughout this period. In light of this case, there may be a need to retest by molecular methods for high risk category patients who were initially diagnosed HIV-positive, but later showing an unexpected clinical course, such as a rising or stable CD4 titre over the years.
Collapse
Affiliation(s)
- V Paranthaman
- Paranthaman Vengadasalam (Corresponding author) Family Medicine Specialist, Jelapang Health Clinic, Ipoh, Malaysia
| | - H L Yip
- Yip Hung Loong @ Elvind Yip Community Based Department, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia.
| | - H B Ker
- Ker Hong Bee Infectious Disease Consultant, Department of Medicine, Hospital Raja PermaisuriBainun, Ipoh, Malaysia. Emai:
| |
Collapse
|
34
|
Rikhtegaran Tehrani Z, Azadmanesh K, Mostafavi E, Soori S, Azizi M, Khabiri A. Development of an integrase-based ELISA for specific diagnosis of individuals infected with HIV. J Virol Methods 2015; 215-216:61-6. [PMID: 25712565 DOI: 10.1016/j.jviromet.2015.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 11/20/2014] [Accepted: 02/13/2015] [Indexed: 11/18/2022]
Abstract
Currently, enzyme immunoassays (EIAs) are the most common immunological diagnostic methods that are used as the screening tool in HIV detection. Among all three major genes of HIV, the products of gag and env are usually used in EIAs (ELISAs and rapid tests). Hence, the presence of cross reacting antibodies against these antigens leads to the appearance of repetitive false positive results in screening tests. Re-testing the primary reactive samples with EIAs using other HIV antigens can considerably reduce the rate of false positive results. The products of pol gene may act as an appropriate candidate in this context. Integrase is a conserved and immunogenic product of HIV, encoded by the pol gene. The aim of this research was to determine the sensitivity and specificity of an ELISA detecting integrase antibodies. Recombinant integrase was produced in Escherichia coli to develop the integrase-based ELISA. Assay performance was evaluated by HIV positive and negative sera and an HIV panel of BBI (PRB-601). The sensitivity and specificity of assay was determined as 96.7 [95% confidence interval: 91.3-98.9%] and 100% [95% CI: 96.1-100%], respectively. High specificity of this assay may suggest its possible use in the detection of HIV.
Collapse
Affiliation(s)
- Zahra Rikhtegaran Tehrani
- Diagnostic Biotechnology Unit, Pasteur institute of Iran, Research and Production complex, Postal Code: 3159915111, 25th kilometer of Tehran-Karaj highway, Iran.
| | - Kayhan Azadmanesh
- Virology Department, Pasteur institute of Iran, No. 69, Pasteur ave, Postal Code: 1316943551, Tehran, Iran.
| | - Ehsan Mostafavi
- Epidemiology Department, Pasteur institute of Iran, No. 69, Pasteur ave, Postal Code: 1316943551, Tehran, Iran.
| | - Shahrzad Soori
- Hematology Department, Iran University of Medical Sciences, Hemmat highway, Postal Code: 1449614535, Tehran, Iran.
| | - Mohammad Azizi
- Biotechnology Department, Pasteur institute of Iran, No. 69, Pasteur ave, Postal Code: 1316943551, Tehran, Iran.
| | - Alireza Khabiri
- Diagnostic Biotechnology Unit, Pasteur Institute of Iran, Research and Production Complex, Postal Code: 3159915111, 25th kilometer of Tehran -Karaj highway, Tehran, Iran.
| |
Collapse
|
35
|
Tagny CT, Mbanya D, Murphy EL, Lefrère JJ, Laperche S. Screening for hepatitis C virus infection in a high prevalence country by an antigen/antibody combination assay versus a rapid test. J Virol Methods 2014; 199:119-23. [PMID: 24487098 DOI: 10.1016/j.jviromet.2014.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/20/2013] [Accepted: 01/03/2014] [Indexed: 12/17/2022]
Abstract
In low-income-countries, screening for hepatitis C virus (HCV) infection is often based on rapid tests (RT). Their lower sensitivity compared to enzyme immunoassay (EIA) suggests that newer HCV Antigen/Antibody (Ag/Ab) combination assays might have a role in such countries. To test this idea, 1998 blood donors were tested at the University Teaching Hospital blood bank in Yaoundé, Cameroon simultaneously with a RT (HCV rapid test, Human Diagnostics, Berlin, Germany) according to standard practice (S1) and with an Ag/Ab assay (Monolisa HCV Ag/Ab Ultra, Biorad, France) (S2). All discordant, borderline and reactive samples were submitted to confirmatory testing by immunoblot and/or HCV-RNA. Of the 86 (4.3%) samples positive with one or both strategies, 29 were confirmed negative, 37 positive and 20 were false positive or resolved infection. There was a significant difference in test sensitivity (p=0.01) between S1 (70.3%) and S2 (91.9%) but not in test specificity (99.4% and 98.6%, respectively). The benefit of the Ag/Ab assay in the detection of recent HCV seronegative infections could not be evaluated since no Antigen-only donations were identified. However, better Ag/Ab test sensitivity compared to RT supports the implementation of these newer immunoassays for HCV screening in the African blood bank setting.
Collapse
Affiliation(s)
- Claude Tayou Tagny
- University Hospital Center, Haematology and Blood Bank Service, Yaoundé, Cameroon; Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
| | - Dora Mbanya
- University Hospital Center, Haematology and Blood Bank Service, Yaoundé, Cameroon; Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
| | - Edward L Murphy
- University of California, San Francisco, and Blood Systems Research Institute, San Francisco, USA
| | - Jean-Jacques Lefrère
- Department for the Study of Blood-borne Agents, Institut National de la Transfusion Sanguine, Paris, France
| | - Syria Laperche
- Department for the Study of Blood-borne Agents, Institut National de la Transfusion Sanguine, Paris, France; National Reference Center for HBV, HCV, HIV in Transfusion, Institut National de la Transfusion Sanguine, Paris, France.
| |
Collapse
|
36
|
Hull R, Dlamini Z. The role played by alternative splicing in antigenic variability in human endo-parasites. Parasit Vectors 2014; 7:53. [PMID: 24472559 PMCID: PMC4015677 DOI: 10.1186/1756-3305-7-53] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 01/17/2014] [Indexed: 01/03/2023] Open
Abstract
Endo-parasites that affect humans include Plasmodium, the causative agent of malaria, which remains one of the leading causes of death in human beings. Despite decades of research, vaccines to this and other endo-parasites remain elusive. This is in part due to the hyper-variability of the parasites surface proteins. Generally these surface proteins are encoded by a large family of genes, with only one being dominantly expressed at certain life stages. Another layer of complexity can be introduced through the alternative splicing of these surface proteins. The resulting isoforms may differ from each other with regard to cell localisation, substrate affinities and functions. They may even differ in structure to the extent that they are no longer recognised by the host’s immune system. In many cases this leads to changes in the N terminus of these proteins. The geographical localisation of endo-parasitic infections around the tropics and the highest incidences of HIV-1 infection in the same areas, adds a further layer of complexity as parasitic infections affect the host immune system resulting in higher HIV infection rates, faster disease progression, and an increase in the severity of infections and complications in HIV diagnosis. This review discusses some examples of parasite surface proteins that are alternatively spliced in trypanosomes, Plasmodium and the parasitic worm Schistosoma as well as what role alternate splicing may play in the interaction between HIV and these endo-parasites.
Collapse
Affiliation(s)
| | - Zodwa Dlamini
- University of South Africa, College of Agriculture and Environmental Sciences, College of Agriculture and Environmental Sciences, C/o Christiaan de Wet and Pioneer Avenue, Private Bag X6, Florida Science Campus, Florida, Johannesburg 1710, South Africa.
| |
Collapse
|
37
|
Witkowski PT, Klempa B, Ithete NL, Auste B, Mfune JKE, Hoveka J, Matthee S, Preiser W, Kruger DH. Hantaviruses in Africa. Virus Res 2014; 187:34-42. [PMID: 24406800 DOI: 10.1016/j.virusres.2013.12.039] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/04/2013] [Accepted: 12/24/2013] [Indexed: 12/21/2022]
Abstract
This paper summarizes the progress in the search for hantaviruses and hantavirus infections in Africa. After having collected molecular evidence of an indigenous African hantavirus in 2006, an intensive investigation for new hantaviruses has been started in small mammals. Various novel hantaviruses have been molecularly identified not only in rodents but also in shrews and bats. In addition, the first African hantavirus, Sangassou virus, has been isolated and functionally characterized in cell culture. Less is known about the ability of these hantaviruses to infect humans and to cause diseases. To date, no hantavirus genetic material could be amplified from patients' specimens collected in Africa. Serological studies in West Africa, based on a battery of screening and confirmatory assays, led to the detection of hantavirus antibodies in the human population and in patients with putative hantavirus disease. In addition to this overview, we present original data from seroepidemiological and field studies conducted in the Southern part of Africa. A human seroprevalence rate of 1.0% (n=1442) was detected in the South African Cape Region whereas no molecular evidence for the presence of hantavirus was found in 2500 small animals trapped in South Africa and Namibia.
Collapse
Affiliation(s)
- Peter T Witkowski
- Institute of Medical Virology, Helmut Ruska Building, Charité - University Medicine Berlin, Charitéplatz 1, D-10117 Berlin, Germany
| | - Boris Klempa
- Institute of Medical Virology, Helmut Ruska Building, Charité - University Medicine Berlin, Charitéplatz 1, D-10117 Berlin, Germany; Institute of Virology, Academy of Sciences, Bratislava, Slovakia
| | - Ndapewa L Ithete
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Brita Auste
- Institute of Medical Virology, Helmut Ruska Building, Charité - University Medicine Berlin, Charitéplatz 1, D-10117 Berlin, Germany
| | - John K E Mfune
- Department of Biological Sciences, University of Namibia, Windhoek, Namibia
| | - Julia Hoveka
- Department of Biological Sciences, University of Namibia, Windhoek, Namibia
| | - Sonja Matthee
- Department of Conservation Ecology and Entomology, Stellenbosch University, Stellenbosch, South Africa
| | - Wolfgang Preiser
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Detlev H Kruger
- Institute of Medical Virology, Helmut Ruska Building, Charité - University Medicine Berlin, Charitéplatz 1, D-10117 Berlin, Germany.
| |
Collapse
|
38
|
Klarkowski D, O’Brien DP, Shanks L, Singh KP. Causes of false-positive HIV rapid diagnostic test results. Expert Rev Anti Infect Ther 2013; 12:49-62. [DOI: 10.1586/14787210.2014.866516] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
39
|
Association of inconclusive sera for human immunodeficiency virus infection with malaria and Epstein-Barr virus infection in Central Africa. J Clin Microbiol 2013; 52:660-2. [PMID: 24478507 DOI: 10.1128/jcm.02945-13] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Among 464 sera from adults in Cameroon, 56 (12.1%) gave inconclusive HIV serology. All were negative for HIV-1 DNA; 44.6% (n = 25) were significantly associated with Plasmodium (42.8%) or Epstein-Barr virus (EBV) (17.8%) infections. In Central Africa, sera giving inconclusive results for HIV are frequently associated with malaria, EBV infection, or both.
Collapse
|
40
|
Klarkowski D, Glass K, O’Brien D, Lokuge K, Piriou E, Shanks L. Variation in specificity of HIV rapid diagnostic tests over place and time: an analysis of discordancy data using a Bayesian approach. PLoS One 2013; 8:e81656. [PMID: 24282615 PMCID: PMC3840056 DOI: 10.1371/journal.pone.0081656] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 10/15/2013] [Indexed: 11/18/2022] Open
Abstract
Background Recent trends to earlier access to anti-retroviral treatment underline the importance of accurate HIV diagnosis. The WHO HIV testing strategy recommends the use of two or three rapid diagnostic tests (RDTs) combined in an algorithm and assume a population is serologically stable over time. Yet RDTs are prone to cross reactivity which can lead to false positive or discordant results. This paper uses discordancy data from Médecins Sans Frontières (MSF) programmes to test the hypothesis that the specificity of RDTs change over place and time. Methods Data was drawn from all MSF test centres in 2007-8 using a parallel testing algorithm. A Bayesian approach was used to derive estimates of disease prevalence, and of test sensitivity and specificity using the software WinBUGS. A comparison of models with different levels of complexity was performed to assess the evidence for changes in test characteristics by location and over time. Results 106, 035 individuals were included from 51 centres in 10 countries using 7 different RDTs. Discordancy patterns were found to vary by location and time. Model fit statistics confirmed this, with improved fit to the data when test specificity and sensitivity were allowed to vary by centre and over time. Two examples show evidence of variation in specificity between different testing locations within a single country. Finally, within a single test centre, variation in specificity was seen over time with one test becoming more specific and the other less specific. Conclusion This analysis demonstrates the variable specificity of multiple HIV RDTs over geographic location and time. This variability suggests that cross reactivity is occurring and indicates a higher than previously appreciated risk of false positive HIV results using the current WHO testing guidelines. Given the significant consequences of false HIV diagnosis, we suggest that current testing and evaluation strategies be reviewed.
Collapse
Affiliation(s)
- Derryck Klarkowski
- Médecins sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands
| | | | - Daniel O’Brien
- Médecins sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands
- Department of Medicine and Infectious Diseases, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Kamalini Lokuge
- Médecins sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands
- Australian National University, Canberra, Australia
| | - Erwan Piriou
- Médecins sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands
| | - Leslie Shanks
- Médecins sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| |
Collapse
|
41
|
Kfutwah A, Lemée V, Ngono HV, De Oliveira F, Njouom R, Plantier JC. Field evaluation of the Abbott ARCHITECT HIV Ag/Ab Combo immunoassay. J Clin Virol 2013; 58 Suppl 1:e70-5. [PMID: 24342480 DOI: 10.1016/j.jcv.2013.08.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/09/2013] [Accepted: 08/17/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Fourth generation assays for HIV diagnosis are progressively being introduced into routine services, due to their improvement of diagnosis. In spite of this, HIV diagnosis remains a challenge in sub-Saharan Africa, due to false positive reactivity. There is a continuous need for field evaluations and routine validations of fourth generation HIV tests in African populations. OBJECTIVES Evaluate the performances of the ARCHITECT HIV Ag/Ab kit (Abbott) in a population living in an African setting-Cameroon compared to a population living in a European setting-France. STUDY DESIGN 645 HIV samples from both France and Cameroon were evaluated. The positive panel (378 samples) included a diverse series of HIV-1 variants (groups M, N, O, and P) as well as HIV-2 samples. Results were compared to original diagnosis done with other 4th generation assays (AxSYM HIV Ag/Ab (Abbott) and Vidas HIV DUO QUICK) (bioMérieux). RESULTS Sensitivity of the ARCHITECT was 100% in both sites. It diagnosed all variants of the panel with different reactivity profiles following strain diversity. A wider range of reactivity was observed for group O. Specificity was slightly lower (97.6%) in Cameroon than in France (98.6%), probably due to a higher rate of false positive reactivity. ARCHITECT HIV Ag/Ab assay had high performances in clinical sensitivity and specificity and is adapted to the wide genetic diversity of viruses circulating in West Central Africa. CONCLUSION Our results further highlight the need to evaluate HIV diagnostic tests before introduction into routine diagnostic services both in the North and in the South.
Collapse
Affiliation(s)
- Anfumbom Kfutwah
- Service de Virologie, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaounde', Cameroun. BP 1274, Yaounde, Cameroon.
| | - Véronique Lemée
- Laboratoire Associé au Centre National de Référence du VIH, Hôpital Charles Nicolle, CHU de Rouen, 76031 Rouen, France
| | - Hélène Valérie Ngono
- Service de Virologie, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaounde', Cameroun. BP 1274, Yaounde, Cameroon
| | - Fabienne De Oliveira
- Laboratoire Associé au Centre National de Référence du VIH, Hôpital Charles Nicolle, CHU de Rouen, 76031 Rouen, France
| | - Richard Njouom
- Service de Virologie, Centre Pasteur du Cameroun, Membre du Réseau International des Instituts Pasteur, Yaounde', Cameroun. BP 1274, Yaounde, Cameroon
| | - Jean-Christophe Plantier
- Laboratoire Associé au Centre National de Référence du VIH, Hôpital Charles Nicolle, CHU de Rouen, 76031 Rouen, France.
| |
Collapse
|
42
|
False positive HIV diagnoses in resource limited settings: operational lessons learned for HIV programmes. PLoS One 2013; 8:e59906. [PMID: 23527284 PMCID: PMC3603939 DOI: 10.1371/journal.pone.0059906] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 02/19/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Access to HIV diagnosis is life-saving; however the use of rapid diagnostic tests in combination is vulnerable to wrongly diagnosing HIV infection when both screening tests give a false positive result. Misclassification of HIV patients can also occur due to poor quality control, administrative errors and lack of supervision and training of staff. Médecins Sans Frontières discovered in 2004 that HIV negative individuals were enrolled in some HIV programmes. This paper describes the result of an audit of three sites to review testing practices, implement improved testing algorithms and offer re-testing to clients enrolled in the HIV clinic. FINDINGS In the Democratic Republic of Congo (DRC), Burundi and Ethiopia patients were identified for HIV retesting. In total, 44 false-positive patients were identified in HIV programmes in DRC, two in Burundi and seven in Ethiopia. Some of those identified had been abandoned by partners or started on anti-retroviral therapy or prophylaxis. Despite potential damage to programme reputations, no impact in terms of testing uptake occurred with mean monthly testing volumes stable after introduction of re-testing. In order to prevent the problem, training, supervision and quality control of testing procedures were strengthened. A simple and feasible confirmation test was added to the test algorithm. Prevalence of false positives after introducing the changes varied from zero percent (95% CI 0%-8.2%) to 10.3 percent (95% CI: 7.2%-14.1%) in Burundi and DRC respectively. CONCLUSION False HIV diagnoses were found in a variety of programme settings and had devastating individual consequences. We re-tested individuals in our programmes while instituting improved testing procedures without a negative impact on test uptake. Considering the importance of correct diagnosis to the individual, as well as the resources needed to care for someone with HIV, it is critical to ensure that all patients registered in HIV programmes are accurately diagnosed.
Collapse
|
43
|
Rifkin SB, Owens LE, Greenwald JL. Factors associated with false-positive results from fingerstick OraQuick ADVANCE rapid HIV 1/2 antibody test. ACTA ACUST UNITED AC 2012; 11:356-60. [PMID: 23015378 DOI: 10.1177/1545109712454194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Identify factors associated with false-positive rapid HIV antibody tests. DESIGN This retrospective cohort study with nested case-controls involved patients tested for HIV by Boston Medical Center (BMC) affiliates. METHODS Cases had a reactive fingerstick OraQuick ADVANCE rapid HIV 1/2 antibody test and a negative Western blot. Controls had nonreactive rapid tests. We compared the prevalence of HIV risk factors between cases and the total nonreactive population and the prevalence of other clinical factors between cases and controls. RESULTS Of the 15 094 tests, 14 937 (98.9%) were negative and 11 (0.07%) were false positives (specificity of 99.9%). Cases were more likely to have had an HIV-infected sex partner and to be tested at certain sites compared to true negatives. More cases than controls had O-negative blood type. CONCLUSION O-negative blood type and sex with an HIV-infected person may increase false-positive HIV fingerstick results. More targeted studies should examine these risk factors.
Collapse
|
44
|
Abstract
PURPOSE OF REVIEW Helminths and HIV-1 use multiple mechanisms to avoid or deviate immune responses, and these mechanisms may interact with important consequences for the epidemiology of each infection. In this review, we summarize recent immunological and epidemiological advances in the understanding of HIV-1-helminth co-infections. RECENT FINDINGS Considering the extent of geographical overlap of these chronic infections, there has been so far surprisingly limited and inconsistent evidence of important interactive effects, either from epidemiological studies examining associations between helminth infection indicators and HIV disease parameters, or from studies that have dissected the immune mechanisms triggered by each pathogen in isolation and investigated their interaction. Systematic reviews have found inconsistent evidence for a beneficial effect of anthelmintic treatment of helminth-HIV-1 co-infected individuals on viral load or CD4 cell counts. It is not certain that co-infection with HIV-1 and helminths will always be more detrimental to the host than either single infection alone, or that intervening against co-infections will have only beneficial effects. SUMMARY A consensus on the implications of co-infection on de-worming and vaccination policies has not yet emerged. Well powered randomized trials in HIV-1-infected individuals with defined helminth infections are required to determine the benefits of anthelmintic interventions.
Collapse
|
45
|
Abstract
PURPOSE OF REVIEW The recent findings pertaining to the public health impact of schistosomiasis on the epidemiology of HIV/AIDS are summarized. RECENT FINDINGS Both empiric data and mathematical models support the hypothesis that schistosome infections lead to increased susceptibility to infection with HIV-1, a more rapid progression to disease through more vigorous viral replication and immunosuppression, and a higher likelihood of transmitting the infection to others through both vertical and horizontal routes. Different species of schistosome infection vary in the magnitude of their effects on these mechanisms with Schistosoma haematobium playing a greater role for increased susceptibility and transmission because of its association with urogenital disease. SUMMARY Schistosomiasis appears to be a cofactor in the spread and progression of HIV/AIDS in areas wherein both diseases are endemic; increased emphasis on treatment of schistosome infections in persons at risk of HIV/AIDS should be pursued.
Collapse
|
46
|
Kroidl I, Clowes P, Mwalongo W, Maganga L, Maboko L, Kroidl AL, Geldmacher C, Machibya H, Hoelscher M, Saathoff E. Low specificity of determine HIV1/2 RDT using whole blood in south west Tanzania. PLoS One 2012; 7:e39529. [PMID: 22768086 PMCID: PMC3387183 DOI: 10.1371/journal.pone.0039529] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 05/23/2012] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate the diagnostic performance of two rapid detection tests (RDTs) for HIV 1/2 in plasma and in whole blood samples. Methods More than 15,000 study subjects above the age of two years participated in two rounds of a cohort study to determine the prevalence of HIV. HIV testing was performed using the Determine HIV 1/2 test (Abbott) in the first (2006/2007) and the HIV 1/2 STAT-PAK Dipstick Assay (Chembio) in the second round (2007/2008) of the survey. Positive results were classified into faint and strong bands depending on the visual appearance of the test strip and confirmed by ELISA and Western blot. Results The sensitivity and specificity of the Determine RDT were 100% (95% confidence interval = 86.8 to 100%) and 96.8% (95.9 to 97.6%) in whole blood and 100% (99.7 to 100%) and 97.9% (97.6 to 98.1%) in plasma respectively. Specificity was highly dependent on the tested sample type: when using whole blood, 67.1% of positive results were false positive, as opposed to 17.4% in plasma. Test strips with only faint positive bands were more often false positive than strips showing strong bands and were more common in whole blood than in plasma. Evaluation of the STAT-PAK RDT in plasma during the second year resulted in a sensitivity of 99.7% (99.1 to 99.9%) and a specificity of 99.3% (99.1 to 99.4%) with 6.9% of the positive results being false. Conclusions Our study shows that the Determine HIV 1/2 strip test with its high sensitivity is an excellent tool to screen for HIV infection, but that – at least in our setting – it can not be recommended as a confirmatory test in VCT campaigns where whole blood is used.
Collapse
Affiliation(s)
- Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Acute Dengue fever causes false-positive reactivity in OraQuick rapid HIV-1/2 antibody test. J Acquir Immune Defic Syndr 2011; 55:641. [PMID: 21931283 DOI: 10.1097/qai.0b013e3181f5b291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
48
|
Amrein K, Valentin A, Lanzer G, Drexler C. Adverse events and safety issues in blood donation--a comprehensive review. Blood Rev 2011; 26:33-42. [PMID: 21996651 DOI: 10.1016/j.blre.2011.09.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Although blood donation is generally safe, a variety of risks and complications exist, the most common being iron deficiency, vasovagal reactions and citrate-related events. In the last decades, extensive efforts have significantly improved recipient and product safety, but there is still great potential to optimise donor care. Many therapies in modern medicine depend on the prompt availability of blood products, therefore it is crucial to maintain a motivated and healthy donor pool in view of a limited number of healthy volunteers willing and able to give blood or blood components. We present a comprehensive review on adverse events addressing all types of blood donation including whole blood, plasma, platelet, peripheral blood stem cell, leucocyte and bone marrow donation. In addition, we outline strategies for the prevention and treatment of these events and give a blueprint for future research in this field.
Collapse
Affiliation(s)
- Karin Amrein
- Medical University of Graz, Department of Internal Medicine, Auenbruggerplatz 15, 8036 Graz, Austria.
| | | | | | | |
Collapse
|
49
|
Crucitti T, Taylor D, Beelaert G, Fransen K, Van Damme L. Performance of a rapid and simple HIV testing algorithm in a multicenter phase III microbicide clinical trial. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2011; 18:1480-5. [PMID: 21752945 PMCID: PMC3165239 DOI: 10.1128/cvi.05069-11] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 07/06/2011] [Indexed: 11/20/2022]
Abstract
A multitest sequential algorithm based on rapid and simple (R/S) assays was applied for the diagnosis of HIV infection among participants in a phase 3 microbicide effectiveness trial. HIV testing was performed on finger-prick blood samples obtained from patients after their enrollment in the trial. The specimens were tested in a serial procedure using three different rapid tests (Determine HIV-1/2 [Abbott], SD Bioline HIV-1/2 3.0 [Standard Diagnostics], and Uni-Gold HIV [Trinity Biotech]). In the event of discordant results between the Determine HIV-1/2 and SD Bioline HIV-1/2 3.0 tests, the third assay (Uni-Gold HIV) determined the final outcome. When the final outcome was positive, a second specimen was collected and tested with the same algorithm, only if a positive result was obtained with this sample the participant was informed of her positive serostatus. A total of 5,734 postenrollment specimens obtained from 1,398 women were tested. Forty-six women tested positive according to the testing algorithm performed on the first collected specimen. Confirmatory testing results obtained at the ITM confirmed that 42 women were truly infected. Two of four initial false positives tested negative upon analysis of a second blood specimen. The other two tested false positive twice using specimens collected the same day. A high percentage of specimens reactive with the Determine HIV-1/2 assay was only observed at the study site in Kampala. This result did not appear to be associated with pregnancy or malaria infection. We conclude that HIV testing algorithms, including only R/S assays, are suitable for use in clinical trials, provided that adequate quality assurance procedures are in place.
Collapse
Affiliation(s)
- Tania Crucitti
- HIV/STI Reference Laboratory, Institute of Tropical Medicine, 155 Nationalestraat, 2000 Antwerp, Belgium.
| | | | | | | | | |
Collapse
|
50
|
Hayes R, Sabapathy K, Fidler S. Universal testing and treatment as an HIV prevention strategy: research questions and methods. Curr HIV Res 2011; 9:429-45. [PMID: 21999778 PMCID: PMC3520051 DOI: 10.2174/157016211798038515] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 07/15/2011] [Accepted: 07/29/2011] [Indexed: 02/07/2023]
Abstract
Achieving high coverage of antiretroviral treatment (ART) in resource-poor settings will become increasingly difficult unless HIV incidence can be reduced substantially. Universal voluntary counselling and testing followed by immediate initiation of ART for all those diagnosed HIV-positive (universal testing and treatment, UTT) has the potential to reduce HIV incidence dramatically but would be very challenging and costly to deliver in the short term. Early modelling work in this field has been criticised for making unduly optimistic assumptions about the uptake and coverage of interventions. In future work, it is important that model parameters are realistic and based where possible on empirical data. Rigorous research evidence is needed before the UTT approach could be considered for wide-scale implementation. This paper reviews the main areas that need to be explored. We consider in turn research questions related to the provision of services for universal testing, services for immediate treatment of HIV-positives and the population-level impact of UTT, and the research methods that could be used to address these questions. Ideally, initial feasibility studies should be carried out to investigate the acceptability, feasibility and uptake of UTT services. If these studies produce promising results, there would be a strong case for a cluster-randomised trial to measure the impact of a UTT intervention on HIV incidence, and we consider the main design features of such a trial.
Collapse
Affiliation(s)
- Richard Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | | | | |
Collapse
|