Use of fourth-generation rapid combined antigen and antibody diagnostic tests for the detection of acute HIV infection in a community centre for men who have sex with men, between 2016 and 2019

Objective To assess the use of fourth-generation rapid diagnostic tests in identifying acute infection of Human Immunodeficiency Virus (HIV). Methods BCN Checkpoint promotes sexual health among men who have sex with men (MSM), with a focus on diagnosing HIV early, initiating combined antiretroviral treatment (cART) promptly, and recommending regular repeat testing for those who have tested negative. This cross-sectional study included all test results obtained at the centre between 25 March 2016 and 24 March 2019. The Alere™ HIV Combo (now rebranded to Determine™ HIV Ultra, from Abbott) was used to detect p24 antigen (p24 Ag) and/or immunoglobulin M (IgM) and G (IgG) antibodies to HIV-1/HIV-2 (HIV Ab). Rapid polymerase chain reaction (PCR) confirmatory testing and Western blot (WB) were performed for clients with a positive rapid test result. Confirmed HIV cases were promptly referred to the HIV unit for care and cART prescription. Results A total of 12,961 clients attended BCN Checkpoint during the study and 27,298 rapid tests were performed. 450 tests were found to be reactive, of which 430 confirmed as HIV-positive, representing a prevalence of 3.32%. Four confirmed cases (0.93%) were detected as “p24 Ag only”, nine (2.09%) as “both p24 and HIV Ab” and 417 (96.98%) as “HIV Ab only”. The “p24 Ag only” group had a 1-log higher viral load than the other groups and initiated treatment on the following working day. Overall, there were 20 false-positive results (0.07% and 4.44% of total and reactive tests, respectively), of which 10 positive for “p24 Ag only” and 10 for “HIV Ab only”. Conclusions Four Acute HIV Infections (AHI), with very high viral loads, have been detected with the “p24 Ag only” while the HIV Ab were still absent. Referral to the HIV unit and initiation of cART on the following working day contributed to improving persons’ health and to reduce HIV transmission chain.

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Correction: Use of fourth-generation rapid combined antigen and antibody diagnostic tests for the detection of acute HIV infection in a community centre for men who have sex with men, between 2016 and 2019

PLoS ONE ◽

10.1371/journal.pone.0258613 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0258613

Author(s):

Keyword(s):

Hiv Infection ◽

Diagnostic Tests ◽

Fourth Generation ◽

Acute Hiv Infection ◽

Acute Hiv ◽

Sex With Men ◽

Community Centre

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Comparison of Detection Limits of Fourth- and Fifth-Generation Combination HIV Antigen-Antibody, p24 Antigen, and Viral Load Assays on Diverse HIV Isolates

Journal of Clinical Microbiology ◽

10.1128/jcm.02045-17 ◽

2018 ◽

Vol 56 (8) ◽

Cited By ~ 16

Author(s):

Mars Stone ◽

John Bainbridge ◽

Ana M. Sanchez ◽

Sheila M. Keating ◽

Andrea Pappas ◽

...

Keyword(s):

Viral Load ◽

Acute Infection ◽

Fourth Generation ◽

Next Generation ◽

Acute Hiv Infection ◽

Viral Loads ◽

Hiv Antigen ◽

Loads Analysis ◽

Acute Hiv ◽

Antigen Antibody

ABSTRACTDetection of acute HIV infection is critical for HIV public health and diagnostics. Clinical fourth-generation antigen (Ag)/antibody (Ab) combination (combo) and p24 Ag immunoassays have enhanced detection of acute infection compared to Ab-alone assays but require ongoing evaluation with currently circulating diverse subtypes. Genetically and geographically diverse HIV clinical isolates were used to assess clinical HIV diagnostic, blood screening, and next-generation assays. Three-hundred-member panels of 20 serially diluted well-characterized antibody-negative HIV isolates for which the researchers were blind to the results (blind panels) were distributed to manufacturers and end-user labs to assess the relative analytic sensitivity of currently approved and preapproved clinical HIV fourth-generation Ag/Ab combo or p24 Ag-alone immunoassays for the detection of diverse subtypes. The limits of detection (LODs) of virus were estimated for different subtypes relative to confirmed viral loads. Analysis of immunoassay sensitivity was benchmarked against confirmed viral load measurements on the blind panel. On the basis of the proportion of positive results on 300 observations, all Ag/Ab combo and standard sensitivity p24 Ag assays performed similarly and within half-log LODs, illustrating the similar breadth of reactivity and diagnostic utility. Ultrasensitive p24 Ag assays achieved dramatically increased sensitivities, while the rapid combo assays performed poorly. The similar performance of the different commercially available fourth-generation assays on diverse subtypes supports their use in broad geographic settings with locally circulating HIV clades and recombinant strains. Next-generation preclinical ultrasensitive p24 Ag assays achieved dramatically improved sensitivity, while rapid fourth-generation assays performed poorly for p24 Ag detection.

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Sexual Behavior During Acute HIV Infection Among Men Who Have Sex With Men, in Los Angeles, California: Table 1.

The Journal of Infectious Diseases ◽

10.1093/infdis/jiw112 ◽

2016 ◽

Vol 213 (12) ◽

pp. 2020-2021 ◽

Cited By ~ 6

Author(s):

Dvora L. Joseph Davey ◽

Matt R. Beymer ◽

Chelsea Roberts ◽

Robert K. Bolan ◽

Jeffrey D. Klausner

Keyword(s):

Sexual Behavior ◽

Los Angeles ◽

Hiv Infection ◽

Acute Hiv Infection ◽

Acute Hiv ◽

Sex With Men

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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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Knowledge and Awareness of Acute Human Immunodeficiency Virus Infection Among Mobile App-Using Men Who Have Sex With Men: A Missed Public Health Opportunity

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv016 ◽

2015 ◽

Vol 2 (1) ◽

Cited By ~ 1

Author(s):

Aaron J. Siegler ◽

Travis Sanchez ◽

R. Craig Sineath ◽

Jeremy Grey ◽

Erin Kahle ◽

...

Keyword(s):

Public Health ◽

Human Immunodeficiency Virus ◽

Hiv Infection ◽

Hiv Testing ◽

Online Survey ◽

Mobile App ◽

Acute Hiv Infection ◽

Immunodeficiency Virus ◽

Acute Hiv ◽

Sex With Men

Abstract In a national online survey, we assessed awareness and knowledge of acute human immunodeficiency virus (HIV) infection manifestation among 1748 men who have sex with men (MSM). Only 39% of respondents were aware that acute HIV infection may be accompanied by symptoms. Education and increased access to acute HIV testing may facilitate MSM to appropriately seek acute HIV testing.

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Estimating the Mutational Fitness Effects Distribution during early HIV infection

10.1101/185678 ◽

2017 ◽

Author(s):

Eva Bons ◽

Frederic Bertels ◽

Roland R Regoes

Keyword(s):

Hiv Infection ◽

Acute Infection ◽

Recent Analysis ◽

Sequencing Data ◽

Acute Hiv Infection ◽

Beneficial Mutations ◽

Fitness Effects ◽

Acute Hiv ◽

High Fraction ◽

The Moment

AbstractThe evolution of HIV during acute infection is often considered a neutral process. Recent analysis of sequencing data from this stage of infection, however, showed high levels of shared mutations between independent viral populations. This suggests that selection might play a role in the early stages of HIV infection. We adapted an existing model for random evolution during acute HIV-infection to include selection. Simulations of this model were used to fit a global mutational fitness effects distribution (MFED) to sequencing data of the env gene of individuals with acute HIV infection. Measures of sharing between viral populations were used as summary statistics to compare the data to the simulations. We confirm that evolution during acute infection is significantly different from neutral. The distribution of mutational fitness effects is best fit by distribution with a low, but significant fraction of beneficial mutations and a high fraction of deleterious mutations. While most mutations are neutral or deleterious in this model, about 5% of mutations is beneficial. These beneficial mutations will, on average, result in a small but significant increase in fitness. When assuming no epistasis, this indicates that at the moment of transmission HIV is near, but not on the fitness peak for early infection.

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Alteration in Oral Microbiome Among Men Who Have Sex With Men With Acute and Chronic HIV Infection on Antiretroviral Therapy

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2021.695515 ◽

2021 ◽

Vol 11 ◽

Author(s):

Shuang Li ◽

Junping Zhu ◽

Bin Su ◽

Huanhuan Wei ◽

Fei Chen ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Hiv Infection ◽

Hiv Infections ◽

Oral Microbiome ◽

People Living With Hiv ◽

Acute Hiv Infection ◽

Cell Counts ◽

Acute Hiv ◽

Sex With Men ◽

Chronic Hiv Infection

Despite the antiretroviral therapy (ART), human immunodeficiency virus (HIV)-related oral disease remains a common problem for people living with HIV (PLWH). Evidence suggests that impairment of immune function in HIV infection might lead to the conversion of commensal bacteria to microorganisms with increased pathogenicity. However, limited information is available about alteration in oral microbiome in PLWH on ART. We performed a longitudinal comparative study on men who have sex with men (MSM) with acute HIV infection (n=15), MSM with chronic HIV infection (n=15), and HIV-uninfected MSM controls (n=15). Throat swabs were collected when these subjects were recruited (W0) and 12 weeks after ART treatment (W12) from the patients. Genomic DNAs were extracted and 16S rRNA gene sequencing was performed. Microbiome diversity was significantly decreased in patients with acute and chronic HIV infections compared with those in controls at the sampling time of W0 and the significant difference remained at W12. An increased abundance of unidentified Prevotellaceae was found in patients with acute and chronic HIV infections. Moreover, increased abundances of Prevotella in subjects with acute HIV infection and Streptococcus in subjects with chronic HIV infection were observed. In contrast, greater abundance in Lactobacillus, Rothia, Lautropia, and Bacteroides was found in controls. After effective ART, Bradyrhizobium was enriched in both acute and chronic HIV infections, whereas in controls, Lactobacillus, Rothia, Clostridia, Actinobacteria, and Ruminococcaceae were enriched. In addition, we found that lower CD4+ T-cell counts (<200 cells/mm3) were associated with lower relative abundances of Haemophilus, Actinomyces, unidentified Ruminococcaceae, and Rothia. This study has shown alteration in oral microbiome resulting from HIV infection and ART. The results obtained warrant further studies in a large number of subjects with different ethnics. It might contribute to improved oral health in HIV-infected individuals.

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