Rapid, Real‐Time Detection of Acute HIV Infection in Patients in Africa

Fiscus, Susan A.; Pilcher, Christopher D.; Miller, William C.; Powers, Kimberly A.; Hoffman, Irving; Price, Matthew A.; Chilongozi, David; Mapanje, Clement; Krysiak, Robert; Gama, Syze; Martinson, Francis; Cohen, Myron S.

doi:10.1086/510755

Cited by 90 publications

(86 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In most published examples of specimen pooling to identify AHI (10,(27)(28)(29)32), individual specimens were first screened for chronic HIV infection using an ELISA for antibodies; ELISA-negative specimens were then pooled and tested using HIV NAAT for the presence of virus. We therefore defined AHI prevalence as the proportion of antibody-negative individuals in the population of interest who would individually test positive by NAAT.…”

Section: Methodsmentioning

confidence: 99%

“…Group testing has also found broader application in blood banks (23,25), entomology (34), genetics (11), pharmaceuticals (14), analytical chemistry (37), and information theory (36). More recently, a number of public health laboratories in the United States (18,27,28,30,32) and elsewhere (4,10,29,33) have adopted new clinical HIV testing algorithms that incorporate specimen pooling with NAAT to identify acute HIV infection (AHI) in the period before HIV antibodies develop.…”

mentioning

confidence: 99%

“…Our goals in this paper were therefore to (i) develop simple, flexible models of group testing for NAAT-based AHI case detection, incorporating explicit assumptions about viral dynamics during AHI and known operating characteristics of enzyme-linked immunosorbent assays (ELISAs) for antibodies and NAATs; (ii) employ these models to compare levels of pooling algorithm sensitivity (PAS), efficiency, and PPVs of different pooling strategies for detection of AHI; and (iii) demonstrate how these models can guide pooling algorithm selection in real-world applications (4,10,(27)(28)(29)33).…”

mentioning

confidence: 99%

See 2 more Smart Citations

Optimizing Screening for Acute Human Immunodeficiency Virus Infection with Pooled Nucleic Acid Amplification Tests

Westreich¹,

Hudgens²,

Fiscus

et al. 2008

J Clin Microbiol

112

View full text Add to dashboard Cite

Recent studies have shown the public health importance of identifying individuals with acute human immunodeficiency virus infection (AHI); however, the cost of nucleic acid amplification testing (NAAT) makes individual testing of at-risk individuals prohibitively expensive in many settings. Pooled NAAT (or group testing) can improve efficiency and test performance of testing for AHI, but optimizing the pooling algorithm can be difficult. We developed simple, flexible biostatistical models of specimen pooling with NAAT for the identification of AHI cases; these models incorporate group testing theory, operating characteristics of biological assays, and a model of viral dynamics during AHI. Pooling algorithm sensitivity, efficiency (test kits used per individual specimen evaluated), and positive predictive value (PPV) were modeled and compared for three simple pooling algorithms: two-stage minipools (D2), three-stage hierarchical pools (D3), and square arrays with master pools (A2m). We confirmed the results by stochastic simulation and produced reference tables and a Web calculator to facilitate pooling by investigators without specific biostatistical expertise. All three pooling strategies demonstrated improved efficiency and PPV for AHI case detection compared to individual NAAT. D3 and A2m algorithms generally provided better efficiency and PPV than D2; additionally, A2m generally exhibited better PPV than D3. Used selectively and carefully, the simple models developed here can guide the selection of a pooling algorithm for the detection of AHI cases in a wide variety of settings.Nucleic acid amplification testing (NAAT) has revolutionized testing for infectious diseases (17), but the technique remains expensive (6, 9, 27) and exhibits poor predictive value in many settings. In the last decade, laboratories have turned to specimen pooling or group testing strategies to increase both the efficiency and the predictive value of NAAT for use in screening for rare diseases (23,24,27,31). In group testing, biological specimens are pooled together, and these pools (rather than the individual specimens) are initially tested. If a pool tests positive, further testing is required to identify individual positive specimens; however, if the pool tests negative, all specimens in that pool are declared negative. Thus, group testing can lead to a decrease in the average number of tests required per specimen evaluated compared to individual testing. Group testing can also lead to higher specificity and thus to higher positive predictive values in a screening setting.

show abstract

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Optimizing Screening for Acute Human Immunodeficiency Virus Infection with Pooled Nucleic Acid Amplification Tests

Westreich¹,

Hudgens²,

Fiscus

et al. 2008

J Clin Microbiol

112

View full text Add to dashboard Cite

show abstract

“…Women who undergo primary HIV-1 infection during pregnancy, however are at high risk of perinatal transmission [2].…”

Section: Introductionmentioning

confidence: 99%

Primary HIV-1 infection during pregnancy: high rate of HIV-1 MTCT in a cohort of patients in southern Brazil

et al. 2008

View full text Add to dashboard Cite

“…Implementation of NAAT over and above standard antibody assays has been shown to increase detection of AHI by 8% (14,16). However, NAAT is currently not routine for adult HIV diagnosis due to its costs and the specialized laboratory infrastructure needed to perform these tests (2).…”

mentioning

confidence: 99%

Should South Africa Be Performing Nucleic Acid Testing on HIV Enzyme-Linked Immunosorbent Assay-Negative Samples?

et al. 2010

View full text Add to dashboard Cite

show abstract

Rapid, Real‐Time Detection of Acute HIV Infection in Patients in Africa

Abstract: Real-time pooled RNA testing for the detection of acute HIV infection is feasible in resource-limited settings. However, parallel rapid testing and p24 antigen testing are technologically simpler and together may detect approximately 90% of acute cases.

Cited by 90 publications

References 19 publications

Optimizing Screening for Acute Human Immunodeficiency Virus Infection with Pooled Nucleic Acid Amplification Tests

Optimizing Screening for Acute Human Immunodeficiency Virus Infection with Pooled Nucleic Acid Amplification Tests

Primary HIV-1 infection during pregnancy: high rate of HIV-1 MTCT in a cohort of patients in southern Brazil

Should South Africa Be Performing Nucleic Acid Testing on HIV Enzyme-Linked Immunosorbent Assay-Negative Samples?

Contact Info

Product

Resources

About