Low Specificities of HIV Diagnostic Tests Caused by
            <i>Trypanosoma brucei gambiense</i>
            Sleeping Sickness

Lejon, Veerle; Ngoyi, Dieudonné Mumba; Ilunga, Médard; Beelaert, Greet; Maes, Ilse; Büscher, Philippe; Fransen, Katrien

doi:10.1128/jcm.00456-10

Cited by 56 publications

(45 citation statements)

References 11 publications

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“…As previously reported [38,77–83], tests and algorithm performance vary across settings, often due to cross-reactivity caused by HIV subtypes, co-infections, comorbidities and possible environmental or population characteristics. Without validating a testing algorithm at a country or regional level, it would not be possible to fully understand the causes of poor performance.…”

Section: Discussionmentioning

confidence: 98%

To err is human, to correct is public health: a systematic review examining poor quality testing and misdiagnosis of HIV status

Johnson

Fonner

Sands

et al. 2017

Journal of the International AIDS Society

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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.

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Section: Discussionmentioning

confidence: 98%

To err is human, to correct is public health: a systematic review examining poor quality testing and misdiagnosis of HIV status

Johnson

Fonner

Sands

et al. 2017

Journal of the International AIDS Society

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“…We hypothesize that in Kampala, Uganda, in particular, participants had undiagnosed endemic non-HIV infections or circulating substances in their blood that may have cross-reacted with the Determine HIV-1/2 test (12). Cross-reactivity of HIV assays is not uncommon; a recent publication reported crossreactivity of the Murex HIV Ag/Ab combination enzyme immunoassay with S. haematobium IgG and a study from our group showed cross-reactivity of the Determine HIV-1/2 test with Trypanosoma brucei gambiense (8,17). The 124 results came from 98 women, and only 2 were ultimately diagnosed with HIV during the trial.…”

Section: Discussionmentioning

confidence: 93%

Performance of a Rapid and Simple HIV Testing Algorithm in a Multicenter Phase III Microbicide Clinical Trial

Crucitti

Taylor

Beelaert

et al. 2011

Clin. Vaccine Immunol.

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“…This results in the production of a wide array of non-specific antibodies that can result in false positive diagnoses [80]. Chronic malaria infection also results in the increase in the levels of HIV RNA as well as a decrease in CD4+ cell number while HIV infection results in the increase in the severity of bouts of malaria [83].…”

Section: Parasites Host Immunity and Hivmentioning

confidence: 99%

The role played by alternative splicing in antigenic variability in human endo-parasites

Hull

Dlamini

2014

Parasites & Vectors

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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.

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Low Specificities of HIV Diagnostic Tests Caused by Trypanosoma brucei gambiense Sleeping Sickness

Cited by 56 publications

References 11 publications

To err is human, to correct is public health: a systematic review examining poor quality testing and misdiagnosis of HIV status

To err is human, to correct is public health: a systematic review examining poor quality testing and misdiagnosis of HIV status

Performance of a Rapid and Simple HIV Testing Algorithm in a Multicenter Phase III Microbicide Clinical Trial

The role played by alternative splicing in antigenic variability in human endo-parasites

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