HIV-1 Recent Infection Testing Algorithm With Antiretroviral Drug Detection to Improve Accuracy of Incidence Estimates

Voetsch, Andrew C.; Duong, Yen T; Stupp, Paul; Saito, Suzue; McCracken, Stephen; Dobbs, Trudy; Winterhalter, Frieda S.; Williams, Daniel B.; Mengistu, Assegid; Mugurungi, Owen; Chikwanda, Prisca; Musuka, Godfrey; Ndongmo, Clement B.; Dlamini, Sindisiwe; Nuwagaba‐Biribonwoha, Harriet; Pasipamire, Munyaradzi; Tegbaru, Belete; Eshetu, Frehywot; Biraro, Samuel; Ward, Jennifer; Aibo, Dorothy; Kabala, Andrew; Mgomella, George; Malewo, Optatus; Mushi, Jeremiah; Payne, Danielle; Mengistu, Yohannes; Asiimwe, Fred; Shang, Judith; Dokubo, E. Kainne; Eno, Laura T.; Bissek, Anne-Cécile Zoung-Kanyi; Kingwara, Leonard; Junghae, Muthoni; Kiiru, John; Mwesigwa, Richard C N; Balachandra, Shirish; Lobognon, Roger; Kampira, Elizabeth; Detorio, Mervi; Yufenyuy, Ernest L.; Brown, Kristin; Patel, Hetal; Parekh, Bharat

doi:10.1097/qai.0000000000002707

Cited by 25 publications

(23 citation statements)

References 16 publications

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“…Also, the lack of antiretroviral detection in the incidence algorithm, when combined with an assumed false recency rate of 0%, may have resulted in a small proportion of long-term infections misclassified as recent in both surveys. However, use of a non-zero FRR would be inappropriate, given the differences in FRR among populations over time and that a non-zero FRR reduces recent cases without improving the positive predictive value of the algorithm [ 41 ]. Lastly, population-level causality between population-level viral load suppression and HIV incidence is difficult to establish without identification and measurement of population-level mechanisms; for example, unmeasured factors, such as transmission risk related to population mobility within sexual networks, may have affected the levels of new HIV infections.…”

Section: Discussionmentioning

confidence: 99%

HIV incidence, viremia, and the national response in Eswatini: Two sequential population-based surveys

et al. 2021

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With the highest HIV incidence and prevalence globally, the government of Eswatini started a substantial scale-up of HIV treatment and prevention services in 2011. Two sequential large population-based surveys were conducted before and after service expansion to assess the impact of the national response. Cross-sectional, household-based, nationally representative samples of adults, ages 18 to 49 years, were sampled in 2011 and 2016. We measured HIV prevalence, incidence (recent infection based on limiting antigen ≤1.5 optical density units and HIV RNA ≥1000 copies/mL), viral load suppression (HIV RNA <1000 copies/mL among all seropositive adults) and unsuppressed viremia (HIV RNA ≥1000 copies/mL among all, regardless of HIV status) and assessed for temporal changes by conducting a trend analysis of the log ratio of proportions, using a Z statistic distribution. HIV prevalence remained stable from 2011 to 2016 [32% versus 30%, p = 0.10]. HIV incidence significantly declined 48% [2.48% versus 1.30%, p = 0.01]. Incidence remained higher among women than men [2011: 3.16% versus 1.83%; 2016: 1.76% versus 0.86%], with a smaller but significant relative reduction among women [44%; p = 0.04] than men [53%; p = 0.09]. The proportion of seropositive adults with viral load suppression significantly increased from 35% to 71% [p < .001]. The proportion of the total adult population with unsuppressed viremia decreased from 21% to 9% [p < .001]. National HIV incidence in Eswatini decreased by nearly half and viral load suppression doubled over a five-year period. Unsuppressed viremia in the total population decreased 58%. These population-based findings demonstrate the national impact of expanded HIV services in a hyperendemic country.

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Section: Discussionmentioning

confidence: 99%

HIV incidence, viremia, and the national response in Eswatini: Two sequential population-based surveys

et al. 2021

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“…The criteria for HIV-1 RI patients included: (1) HIV-1 RRITS line score T 1 < L3; Of note, T 1 line was specifically designed to distinguish HIV-1 RI and LI according to its density or score since the coating antigen in T1 line can specifically bind mature anti-gp41 antibody with high avidity, which is usually found in HIV-1 long-term infection, but not in recent infection. (2) HIV-1 diagnosis ≤ 1 year ( Rice et al, 2020 ; de Wit et al, 2021 ; Teixeira et al, 2021 ); (3) baseline CD4 + T-cell counts ≥ 200 cells/μl ( Chauhan et al, 2020 ; Karatzas-Delgado et al, 2020 ; Zhu et al, 2020 ; Ang et al, 2021 ; Teixeira et al, 2021 ); (4) baseline HIV-1 RNA level ≥ 1,000 copies/ml ( Rice et al, 2020 ; Zhu et al, 2020 ; de Wit et al, 2021 ; Rwibasira et al, 2021 ; Voetsch et al, 2021 ). Otherwise, the HIV-1 patients were considered as long-term infection (LI) of HIV-1.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of antiretroviral therapy effect and prognosis between HIV-1 recent and long-term infection based on a rapid recent infection testing algorithm

et al. 2022

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Early diagnosis of HIV-1 infection and immediate initiation of combination antiretroviral therapy (cART) are important for achieving better virological suppression and quicker immune reconstitution. However, no serological HIV-1 recency testing assay has been approved for clinical use, and the real-world clinical outcomes remain to be explored for the subjects with HIV-1 recent infection (RI) or long-term infection (LI) when antiretroviral therapy is initiated. In this study, a HIV-1 rapid recent-infection testing strip (RRITS) was developed and incorporated into the recent infection testing algorithms (RITAs) to distinguish HIV-1 RI and LI and to assess their clinical outcomes including virological response, the recovery of CD4+ T-cell count and CD4/CD8 ratio and the probability of survival. We found that the concordance between our RRITS and the commercially available LAg-Avidity EIA was 97.13% and 90.63% when detecting the longitudinal and cross-sectional HIV-1 positive samples, respectively. Among the 200 HIV-1 patients analyzed, 22.5% (45/200) of them were RI patients and 77.5% (155/200) were chronically infected and 30% (60/200) of them were AIDS patients. After cART, 4.1% (5/155) of the LI patients showed virological rebound, but none in the RI group. The proportion of CD4+ T-cell count >500 cells/mm3 was significantly higher in RI patients than in LI after 2 years of cART with a hazard ratio (HR) of 2.6 (95% CI: 1.9, 3.6, p < 0.0001) while the probability of CD4/CD8 = 1 was higher in RI than in LI group with a HR of 3.6 (95% CI: 2.2, 5.7, p < 0.0001). Furthermore, the immunological recovery speed was 16 cells/mm3/month for CD4+ T-cell and 0.043/month for the ratio of CD4/CD8 in the RI group, and was bigger in the RI group than in the LI patients (p < 0.05) during the 1st year of cART. The survival probability for LI patients was significantly lower than that for RI patients (p < 0.001). Our results indicated that RRITS combined with RITAs could successfully distinguish HIV-1 RI and LI patients whose clinical outcomes were significantly different after cART. The rapid HIV-1 recency test provides a feasible assay for diagnosing HIV-1 recent infection and a useful tool for predicting the outcomes of HIV-1 patients.

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“…Testing algorithms often include information on viral load in particular but also on ART and have given quite reliable results in many settings [ 83 , 91 , 92 , 95 , 106 , 129 , 130 , 131 ] ( Table 2 ). Of interest, in a very large household-based study of more than 18,000 individuals in a high-prevalence setting (Swaziland), a RITA based on Lag (≤1.5 ODn) and viral load (≥1000 copies/mL), along with NAT testing of HIV-negative people for acute infection, produced very similar estimates of incidence (2.6%) compared to that based on the follow-up observation and testing of the same individuals (2.4%) [ 108 , 132 ].…”

Section: Use Of Recency Assays In Hiv Incidence Estimationsmentioning

confidence: 99%

Recent HIV Infection: Diagnosis and Public Health Implications

Nikolopoulos

Tsantes

2022

Diagnostics

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The early period of infection with human immunodeficiency virus (HIV) has been associated with higher infectiousness and, consequently, with more transmission events. Over the last 30 years, assays have been developed that can detect viral and immune biomarkers during the first months of HIV infection. Some of them depend on the functional properties of antibodies including their changing titers or the increasing strength of binding with antigens over time. There have been efforts to estimate HIV incidence using antibody-based assays that detect recent HIV infection along with other laboratory and clinical information. Moreover, some interventions are based on the identification of people who were recently infected by HIV. This review summarizes the evolution of efforts to develop assays for the detection of recent HIV infection and to use these assays for the cross-sectional estimation of HIV incidence or for prevention purposes.

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HIV-1 Recent Infection Testing Algorithm With Antiretroviral Drug Detection to Improve Accuracy of Incidence Estimates

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 25 publications

References 16 publications

HIV incidence, viremia, and the national response in Eswatini: Two sequential population-based surveys

HIV incidence, viremia, and the national response in Eswatini: Two sequential population-based surveys

Evaluation of antiretroviral therapy effect and prognosis between HIV-1 recent and long-term infection based on a rapid recent infection testing algorithm

Recent HIV Infection: Diagnosis and Public Health Implications

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