Diagnosing acute HIV infection at point of care: a retrospective analysis of the sensitivity and specificity of a fourth-generation point-of-care test for detection of HIV core protein p24

The retrospective analysis of case histories of HIV- infected persons is carried out. It is established that in 62 patients there were clinical manifestations of acute HIV-infection: lymphadenopathy (60%), fever (71,2%), eruption (6,5%), diarrhea (3%), herpetic infection (3%), body mass decrease (30%), neurologic symptomatology. The growth of the number of persons with fresh" infections HIV is noted in Kazan and in most regions of Tatarstan Republic. Expected increase of persons with acute stages of HIV infection taking medical advice demands being on guard of medical workers of various specialities.

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Point-of-Care Diagnostics for Acute HIV Infection: An Important Public Health Priority

The Journal of Infectious Diseases ◽

10.1093/infdis/jis618 ◽

2012 ◽

Vol 206 (12) ◽

pp. 1949-1950 ◽

Cited By ~ 1

Author(s):

N. E. Rosenberg ◽

G. Kamanga ◽

S. Phiri ◽

D. Nsona ◽

A. Pettifor ◽

...

Keyword(s):

Public Health ◽

Hiv Infection ◽

Point Of Care ◽

Acute Hiv Infection ◽

Important Public Health ◽

Public Health Priority ◽

Health Priority ◽

Point Of Care Diagnostics ◽

Acute Hiv

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Identification of Acute HIV Infection Using Fourth-Generation Testing in an Opt-Out Emergency Department Screening Program

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2014.05.021 ◽

2014 ◽

Vol 64 (5) ◽

pp. 537-546 ◽

Cited By ~ 28

Author(s):

Kara I. Geren ◽

Frank Lovecchio ◽

Jason Knight ◽

Robert Fromm ◽

Eric Moore ◽

...

Keyword(s):

Emergency Department ◽

Hiv Infection ◽

Screening Program ◽

Fourth Generation ◽

Acute Hiv Infection ◽

Opt Out ◽

Acute Hiv

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Sensitivity of the STAT-VIEW rapid self-test and implications for use during acute HIV infection

Sexually Transmitted Infections ◽

10.1136/sextrans-2017-053131 ◽

2017 ◽

Vol 94 (7) ◽

pp. 475-478 ◽

Cited By ~ 1

Author(s):

Narjis Boukli ◽

Anders Boyd ◽

Noémie Wendremaire ◽

Pierre-Marie Girard ◽

Julie Bottero ◽

...

Keyword(s):

Hiv Infection ◽

Point Of Care ◽

Rapid Test ◽

Detection Sensitivity ◽

Serum Samples ◽

Acute Hiv Infection ◽

Hiv Rna ◽

Rapid Tests ◽

Acute Hiv ◽

Self Test

ObjectivesHIV testing is an important step towards diminishing incident infections. Rapid self-tests whose use is becoming more common in France could help increase access to testing, yet could fail to diagnose HIV during acute HIV infection (AHI). The aim of the present study was to evaluate HIV-detection sensitivity of a commonly used rapid self-test (STAT-VIEW HIV1/2), compared with another point-of-care rapid test (INSTI), among patients presenting with AHI.MethodsIndividuals tested at Saint-Antoine Hospital (Paris, France) with negative or indeterminate western blot (WB) results and detectable HIV-RNA were included. Rapid tests were performed retrospectively on stored serum. Patients with and without reactive rapid tests were compared, while probability of having a reactive test was modelled across infection duration using logistic regression.ResultsOf the 40 patients with AHI, 23 (57.5%) had a reactive STAT-VIEW rapid test. Patients with non-reactive versus reactive tests had a significantly shorter median time since infection (p=0.01), time since onset of symptoms (p=0.009), higher proportion with Fiebig stage III versus IV (p=0.003), negative WB results (p=0.007), higher HIV-RNA levels (p=0.001) and lower CD4+ and CD8+ cell count (p=0.03, p<0.001, respectively). When examining sensitivity over the course of AHI duration, the probability of HIV detection was 75.5% at 5 weeks from HIV transmission. The INSTI provided similar results with respect to proportion of reactive tests (62.5%), determinants for non-reactive test and probability of HIV detection at 5 weeks of infection (85.0%).ConclusionsOver half of AHI patients had reactive serology using the STAT-VIEW rapid self-test when performed on serum samples. Considering that detection sensitivity increased substantially over infection time, individuals should not rely on a negative result to accurately exclude HIV infection within at least 5 weeks of potential HIV exposure. Notwithstanding strong recommendations against rapid test use during AHI, some utility in detecting HIV is observed 5–12 weeks after transmission.

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Acute HIV infection (AHI): Trained Service Linkage Workers and fourth-generation Assay Significantly Shorten Time to Antiretroviral Therapy Initiation.

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1118 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S441-S441

Author(s):

Daniel Smith ◽

Qianmiao Gao ◽

Hongyu Miao ◽

Oswaldo Gutierrez ◽

Cecilio Martinez ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Hiv Infection ◽

Fourth Generation ◽

Acute Hiv Infection ◽

Therapy Initiation ◽

Acute Hiv

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Laboratory Diagnosis and Monitoring of HIV Infection

Tutorial Topics in Infection for the Combined Infection Training Programme ◽

10.1093/oso/9780198801740.003.0067 ◽

2019 ◽

Author(s):

Anna Jeffery- Smith ◽

C. Y. William Tong

Keyword(s):

Hiv Infection ◽

Sensitivity And Specificity ◽

Point Of Care ◽

Fourth Generation ◽

Third Generation ◽

Window Period ◽

P24 Antigen ◽

Exposure Risks ◽

Positive Results ◽

Hiv 1

In the majority of UK laboratories initial testing for HIV is now performed using a fourth generation test, which is a combination test for antibody to HIV and p24 antigen. These tests should be able to detect antibody to both HIV-1 and HIV-2. In addition, due to the heterogeneity of the virus they should be able to reliably detect antibody to the main circulating subtypes of HIV-1, i.e. group M (Major), O (Outlier), and N (non-M, non-O). The p24 antigen is an HIV capsid protein which is produced in large quantities during initial infection, prior to seroconversion. The sensitivity and specificity of fourth generation tests is typically > 99%. However, all positive results need further confirmation tests, as discussed below. Third generation laboratory assays only test for the presence of antibody to HIV. Though it includes the detection of IgM (which is not included in second generation assays), they do not detect early infection with isolated HIV antigen prior to seroconversion. Point-of-care testing for HIV is performed in the clinic or at bedside. Like laboratory based assays these tests can be either third or fourth generation. The sensitivity and specificity of point-of-care tests is considered lower than that of laboratory tests, and all positive results require confirmation with a laboratory assay. The window period is the length of time following infection with HIV until the appearance of laboratory markers of HIV infection in the blood. This period varies depending on which marker, i.e. antibody or antigen, is being tested for. The window period for fourth-generation tests is between eleven days and one month. Patients being counselled prior to this testing should be advised that a negative result does not cover risk exposures in the preceding month. These patients should be advised to have repeat testing if they have any further exposure risks in the preceding month prior to testing. For third-generation tests the window period is up to three months, correlating with the amount of time it may take for antibodies to HIV to develop.

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