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Beard JW, Hunt SL, Evans A, Goenner C, Miller BL. Mimicking an in cellulo environment for enzyme-free paper-based nucleic acid tests at the point of care. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.27.582375. [PMID: 38464301 PMCID: PMC10925243 DOI: 10.1101/2024.02.27.582375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Point of care (PoC) nucleic acid amplification tests (NAATs) are a cornerstone of public health, providing the earliest and most accurate diagnostic method for many communicable diseases, such as HIV, in the same location the patient receives treatment. Communicable diseases disproportionately impact low-resource communities where NAATs are often unobtainable due to the resource intensive enzymes that drive the tests. Enzyme-free nucleic acid detection methods, such as hybridization chain reaction (HCR), use DNA secondary structures for self-driven amplification schemes producing large DNA nanostructures and capable of single molecule detection in cellulo. These thermodynamically driven DNA-based tests have struggled to penetrate the PoC diagnostic field due to their inadequate limits of detection or complex workflows. Here we present a proof-of-concept NAAT that combines HCR-based amplification of a target nucleic acid sequence with paper-based nucleic acid filtration and enrichment capable of detecting sub pM levels of synthetic DNA. We reconstruct the favorable hybridization conditions of an in cellulo reaction in vitro by incubating HCR in an evaporating, microvolume environment containing poly(ethylene glycol) as a crowding agent. We demonstrate that the kinetics and thermodynamics of DNA-DNA and DNA-RNA hybridization is enhanced by the dynamic evaporating environment and inclusion of crowding agents, bringing HCR closer to meeting PoC NAAT needs.
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Affiliation(s)
- Jeffrey W. Beard
- Department of Dermatology, University of Rochester, Rochester, NY 14627, USA
| | - Samuel L. Hunt
- Department of Dermatology, University of Rochester, Rochester, NY 14627, USA
| | - Alexander Evans
- Department of Biomedical Engineering, University of Rochester, Rochester, NY 14627, USA
| | - Coleman Goenner
- Department of Biochemistry and Biophysics, University of Rochester, Rochester, NY 14627, USA
| | - Benjamin L. Miller
- Department of Dermatology, University of Rochester, Rochester, NY 14627, USA
- Department of Biomedical Engineering, University of Rochester, Rochester, NY 14627, USA
- Department of Biochemistry and Biophysics, University of Rochester, Rochester, NY 14627, USA
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Chen Y, Zhao J, Sun P, Cheng M, Xiong Y, Sun Z, Zhang Y, Li K, Ye Y, Shuai P, Huang H, Li X, Liu Y, Wan Z. Estimates of the global burden of non-Hodgkin lymphoma attributable to HIV: a population attributable modeling study. EClinicalMedicine 2024; 67:102370. [PMID: 38130708 PMCID: PMC10733638 DOI: 10.1016/j.eclinm.2023.102370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
Background Human immunodeficiency virus (HIV) significantly increases the risk of non-Hodgkin lymphoma (NHL) development, yet the population-level impact on NHL burden is unquantified. We aim to quantify this association and estimate the global burden of HIV-associated NHL. Methods In this meta-analysis, we searched five databases (PubMed, EMBASE, Cochrane Library, Web of Science, Scopus) from database inception up to September 13, 2023, identifying cohort, case-control, or cross-sectional studies with an effective control group to assess NHL risk among individuals with HIV infection, with two authors extracting summary data from reports. Global and regional HIV-associated population attributable fraction (PAF) and NHL disease burden were calculated based on the pooled risk ratio (RR). HIV prevalence and NHL incidence were obtained from the Joint United Nations Programme on HIV/AIDS (UNAIDS) and Global Burden of Diseases, Injuries, and Risk Factors Study 2019. Trends in NHL incidence due to HIV were assessed using age-standardised incidence rate (ASIR) and estimated annual percentage change (EAPC). This study was registered with PROSPERO (CRD42023404150). Findings Out of 14,929 literature sources, 39 articles met our inclusion criteria. The risk of NHL was significantly increased in the population living with HIV (pooled RR 23.51, 95% CI 17.62-31.37; I2 = 100%, p < 0.0001), without publication bias. Globally, 6.92% (95% CI 2.18%-11.57%) of NHL new cases in 2019 were attributable to HIV infection (30,503, 95% CI 9585-52,209), which marked a more than three-fold increase from 1990 (8340, 95% CI 3346-13,799). The UNAIDS region of Eastern and Southern Africa was the highest affected region, with 44.46% (95% CI 19.62%-58.57%) of NHL new cases attributed to HIV infection. The Eastern Europe and Central Asia region experienced the highest increase in ASIR of NHL due to HIV in the past thirty years, wherein the EAPC was 8.74% (95% CI 7.66%-9.84%), from 2010 to 2019. Interpretation People with HIV infection face a significantly increased risk of NHL. Targeted prevention and control policies are especially crucial for countries in Eastern and Southern Africa, Eastern Europe and Central Asia, to achieve the UNAIDS's '90-90-90' Fast-Track targets. Limited studies across diverse regions and heterogeneity between research have hindered precise estimations for specific periods and regions. Funding Sichuan Provincial People's Hospital, Chengdu, China; Health Care for Cadres of Sichuan Province, Chengdu, China; Science and Technology Department of Sichuan Province, Chengdu, China.
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Affiliation(s)
- Yan Chen
- Department of Health Management Centre & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Jianhui Zhao
- Department of School of Public Health, Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China
| | - Ping Sun
- Department of Health Management Centre & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Mengli Cheng
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory of Drug-Resistant Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumour Institute, Beijing, China
| | - Yiquan Xiong
- Chinese Evidence-based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaochen Sun
- Department of Health Management Centre & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Yixuan Zhang
- Department of School of Public Health, Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China
| | - Kangning Li
- Department of School of Public Health, Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunli Ye
- School of Public Health, Southwest Medical University, Luzhou, China
| | - Ping Shuai
- Department of Health Management Centre & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hairong Huang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory of Drug-Resistant Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumour Institute, Beijing, China
| | - Xue Li
- Department of School of Public Health, Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuping Liu
- Department of Health Management Centre & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhengwei Wan
- Department of Health Management Centre & Institute of Health Management, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Abdullah, Din M, Waris A, Khan M, Ali S, Muhammad R, Salman M. The contemporary immunoassays for HIV diagnosis: a concise overview. ASIAN BIOMED 2023; 17:3-12. [PMID: 37551202 PMCID: PMC10405330 DOI: 10.2478/abm-2023-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Recent advances in human immunodeficiency virus (HIV) diagnostics have improved the management of disease progression significantly, which have also boosted the efficacy of antiviral therapies. The detection of HIV at the earliest is very important. A highly recognized and effective virological biomarker for acute HIV infections is p24 antigen. This brief overview is based on advances of HIV diagnosis while focusing on the latest HIV testing technologies including HIV-specific antigens detecting assays of both anti-HIV antibodies and p24 antigen. In addition to other emerging molecular diagnostics for acute HIV infection, the utilization of p24 antigen has been summarized. Moreover, it has been explained how these immunoassays have reduced the window period for detection of HIV in the acute stage of infection.
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Affiliation(s)
- Abdullah
- Department of Health and Biological Sciences, Abasyn University Peshawar, Peshawar25000, Pakistan
| | - Misbahud Din
- Department of Biotechnology, Quaid-i-Azam University Islamabad, Islamabad45320, Pakistan
| | - Abdul Waris
- Department of Biomedical Sciences, City University of Hong Kong, Shezhen518057, Hong Kong SAR
| | - Muddasir Khan
- Centre of Biotechnology and Microbiology, University of Peshawar, Peshawar25120, Pakistan
| | - Sajjad Ali
- Department of Zoology, University of Buner, Buner19281, Pakistan
| | - Riaz Muhammad
- Department of Health and Biological Sciences, Abasyn University Peshawar, Peshawar25000, Pakistan
- Department of Zoology, Government Degree College Lakarai, Mohmand24651, Pakistan
| | - Muhammad Salman
- Department of Health and Biological Sciences, Abasyn University Peshawar, Peshawar25000, Pakistan
- Department of Veterinary Microbiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok10330, Thailand
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Sanders EJ, Agutu C, van der Elst E, Hassan A, Gichuru E, Mugo P, Farquhar C, Babigumira JB, Goodreau SM, Hamilton DT, Ndung'u T, Sirengo M, Chege W, Graham SM. Effect of an opt-out point-of-care HIV-1 nucleic acid testing intervention to detect acute and prevalent HIV infection in symptomatic adult outpatients and reduce HIV transmission in Kenya: a randomized controlled trial. HIV Med 2022; 23:16-28. [PMID: 34431196 PMCID: PMC9204714 DOI: 10.1111/hiv.13157] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/23/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND In sub-Saharan Africa, adult outpatients with symptoms of acute infectious illness are not routinely tested for prevalent or acute HIV infection (AHI) when seeking healthcare. METHODS Adult symptomatic outpatients aged 18-39 years were evaluated by a consensus AHI risk score. Patients with a risk score ≥ 2 and no previous HIV diagnosis were enrolled in a stepped-wedge trial of opt-out delivery of point-of-care (POC) HIV-1 nucleic acid testing (NAAT), compared with standard provider-initiated HIV testing using rapid tests in the observation period. The primary outcome was the number of new diagnoses in each study period. Generalized estimating equations with a log-binomial link and robust variance estimates were used to account for clustering by health facility. The trial is registered with ClinicalTrials.gov NCT03508908. RESULTS Between 2017 and 2020, 13 (0.9%) out of 1374 participants in the observation period and 37 (2.5%) out of 1500 participants in the intervention period were diagnosed with HIV infection. Of the 37 newly diagnosed cases in the intervention period, two (5.4%) had AHI. Participants in the opt-out intervention had a two-fold greater odds of being diagnosed with HIV (odds ratio = 2.2, 95% confidence interval: 1.39-3.51) after adjustment for factors imbalanced across study periods. CONCLUSIONS Among symptomatic adults aged 18-39 years targeted by our POC NAAT intervention, we identified one chronic HIV infection for every 40 patients and one AHI patient for every 750 patients tested. Although AHI yield was low in this population, routinely offered opt-out testing could diagnose twice as many patients as an approach relying on provider discretion.
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Affiliation(s)
- Eduard J. Sanders
- KEMRI ‐ Wellcome Trust Research ProgrammeKilifiKenya,University of OxfordHeadingtonUK
| | - Clara Agutu
- KEMRI ‐ Wellcome Trust Research ProgrammeKilifiKenya
| | | | - Amin Hassan
- KEMRI ‐ Wellcome Trust Research ProgrammeKilifiKenya
| | | | - Peter Mugo
- KEMRI ‐ Wellcome Trust Research ProgrammeKilifiKenya
| | - Carey Farquhar
- Department of Medicine, Global Health, and EpidemiologyUniversity of WashingtonSeattleWAUSA
| | | | - Steven M. Goodreau
- Department of Anthropology and EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Deven T. Hamilton
- Center for Studies in Demography & EcologyUniversity of WashingtonSeattleWAUSA
| | | | | | - Wairimu Chege
- National Institutes of Allergy & Infectious DiseasesNational Institutes of HealthRockvilleMDUSA
| | - Susan M. Graham
- University of OxfordHeadingtonUK,Department of Medicine, Global Health, and EpidemiologyUniversity of WashingtonSeattleWAUSA
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Crowell TA, Ritz J, Coombs RW, Zheng L, Eron JJ, Mellors JW, Dragavon J, van Zyl GU, Lama JR, Ruxrungtham K, Grinsztejn B, Arduino RC, Fox L, Ananworanich J, Daar ES. Novel Criteria for Diagnosing Acute and Early Human Immunodeficiency Virus Infection in a Multinational Study of Early Antiretroviral Therapy Initiation. Clin Infect Dis 2021; 73:e643-e651. [PMID: 33382405 DOI: 10.1093/cid/ciaa1893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) initiation during acute and early human immunodeficiency virus infection (AEHI) limits HIV reservoir formation and may facilitate post-ART control but is logistically challenging. We evaluated the performance of AEHI diagnostic criteria from a prospective study of early ART initiation. METHODS AIDS Clinical Trials Group A 5354 enrolled adults at 30 sites in the Americas, Africa, and Asia who met any 1 of 6 criteria based on combinations of results of HIV RNA, HIV antibody, Western blot or Geenius assay, and/or the signal-to-cutoff (S/CO) ratio of the ARCHITECT HIV Ag/Ab Combo or GS HIV Combo Ag/Ab EIA. HIV status and Fiebig stage were confirmed by centralized testing. RESULTS From 2017 through 2019, 195 participants were enrolled with median age of 27 years (interquartile range, 23-39). Thirty (15.4%) were female. ART was started by 171 (87.7%) on the day of enrollment and 24 (12.3%) the next day. AEHI was confirmed in 188 (96.4%) participants after centralized testing, 4 (2.0%) participants were found to have chronic infection, and 3 (1.5%) found not to have HIV discontinued ART and were withdrawn. Retrospectively, a nonreactive or indeterminate HIV antibody on the Geenius assay combined with ARCHITECT S/CO ≥10 correctly identified 99 of 122 (81.2%) Fiebig II-IV AEHI cases with no false-positive results. CONCLUSIONS Novel AEHI criteria that incorporate ARCHITECT S/CO facilitated rapid and efficient ART initiation without waiting for an HIV RNA result. These criteria may facilitate AEHI diagnosis, staging, and immediate ART initiation in future research studies and clinical practice. CLINICAL TRIALS REGISTRATION NCT02859558.
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Affiliation(s)
- Trevor A Crowell
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Justin Ritz
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Robert W Coombs
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Lu Zheng
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Joseph J Eron
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John W Mellors
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joan Dragavon
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Gert U van Zyl
- Department of Pathology, Stellenbosch University, Cape Town, South Africa
| | - Javier R Lama
- Asociación Civil Impacta Salud y Educación, Lima, Peru
| | - Kiat Ruxrungtham
- Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Roberto C Arduino
- Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Lawrence Fox
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Jintanat Ananworanich
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric S Daar
- Lundquist Institute at Harbor-University of California-Los Angeles Medical Center, Torrance, California, USA
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Liu Y, Zhan L, Qin Z, Sackrison J, Bischof JC. Ultrasensitive and Highly Specific Lateral Flow Assays for Point-of-Care Diagnosis. ACS NANO 2021; 15:3593-3611. [PMID: 33607867 DOI: 10.1021/acsnano.0c10035] [Citation(s) in RCA: 228] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Lateral flow assays (LFAs) are paper-based point-of-care (POC) diagnostic tools that are widely used because of their low cost, ease of use, and rapid format. Unfortunately, traditional commercial LFAs have significantly poorer sensitivities (μM) and specificities than standard laboratory tests (enzyme-linked immunosorbent assay, ELISA: pM-fM; polymerase chain reaction, PCR: aM), thus limiting their impact in disease control. In this Perspective, we review the evolving efforts to increase the sensitivity and specificity of LFAs. Recent work to improve the sensitivity through assay improvement includes optimization of the assay kinetics and signal amplification by either reader systems or additional reagents. Together, these efforts have produced LFAs with ELISA-level sensitivities (pM-fM). In addition, sample preamplification can be applied to both nucleic acids (direct amplification) and other analytes (indirect amplification) prior to LFA testing, which can lead to PCR-level (aM) sensitivity. However, these amplification strategies also increase the detection time and assay complexity, which inhibits the large-scale POC use of LFAs. Perspectives to achieve future rapid (<30 min), ultrasensitive (PCR-level), and "sample-to-answer" POC diagnostics are also provided. In the case of LFA specificity, recent research efforts have focused on high-affinity molecules and assay optimization to reduce nonspecific binding. Furthermore, novel highly specific molecules, such as CRISPR/Cas systems, can be integrated into diagnosis with LFAs to produce not only ultrasensitive but also highly specific POC diagnostics. In summary, with continuing improvements, LFAs may soon offer performance at the POC that is competitive with laboratory techniques while retaining a rapid format.
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Affiliation(s)
- Yilin Liu
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Li Zhan
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Zhenpeng Qin
- Department of Mechanical Engineering, University of Texas at Dallas, Richardson, Texas 75080 United States
- Department of Bioengineering, University of Texas at Dallas, Richardson, Texas 75080, United States
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390, United States
- Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, Texas 75080, United States
| | - James Sackrison
- 3984 Hunters Hill Way, Minnetonka, Minnesota 55345, United States
| | - John C Bischof
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, United States
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, United States
- Director, Institute of Engineering in Medicine, University of Minnesota, Minneapolis, Minnesota 55455, United States
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Candotti D, Tagny-Tayou C, Laperche S. Challenges in transfusion-transmitted infection screening in Sub-Saharan Africa. Transfus Clin Biol 2021; 28:163-170. [PMID: 33515730 DOI: 10.1016/j.tracli.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In Sub-Saharan Africa, high clinical demand for transfusion faces endemic bloodborne infections and limited resources. Blood screening for transfusion-transmitted bloodborne pathogens is the cornerstone of blood safety. Although there have been substantial improvements over the years, challenges in transfusion-transmitted infection screening that have been identified repeatedly long ago still need to be addressed. Affordability and sustainability of state-of-the-art quality assessed serological and molecular assays, and associated confirmation strategies remain of real concern. In addition, limited resources and infrastructures hamper the development of adequate facilities, quality management, and staff qualification, and exacerbate shortage of reagents and equipment maintenance. It is also important to maintain effort in constituting pools of repeat voluntary non-remunerated donors. Alternative strategies for blood screening that take into account local circumstances might be desirable but they should rely on appropriate field evaluation and careful economic assessment rather than dogma established from high-resource settings.
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Affiliation(s)
- D Candotti
- Département d'Études des Agents Transmissibles par le Sang, Institut National de la Transfusion Sanguine, Centre National de Référence Risques Infectieux Transfusionnels, 75015 Paris, France.
| | - C Tagny-Tayou
- Department of Hematology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, BP: 1364, Yaoundé, Cameroon
| | - S Laperche
- Département d'Études des Agents Transmissibles par le Sang, Institut National de la Transfusion Sanguine, Centre National de Référence Risques Infectieux Transfusionnels, 75015 Paris, France
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