Short Communication: False Recent Ratio of the Limiting-Antigen Avidity Assay and Viral Load Testing Algorithm Among Cameroonians with Long-Term HIV Infection

Lynch, Briana; Patel, Eshan U.; Courtney, Colleen R.; Nanfack, Aubin; Bimela, Jude; Wang, Xiaohong; Eid, Issa; Quinn, Thomas C.; Laeyendecker, Oliver; Nyambi, Phillipe N.; Duerr, Ralf; Redd, Andrew D.

doi:10.1089/aid.2017.0084

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…The incidence was calculated based on recent infection assays which may vary according to the different HIV subtypes. Possible misclassifications using standard LAg avidity assay and VL algorithm had been reported in Cameroun [6]. Cameroon has a similar subtype distribution as Nigeria although the circulating viral subtypes may be similar, our study did not determine it.…”

Section: Discussionmentioning

confidence: 73%

“…Several assays that classify HIV-reactive specimens have been developed or adapted to distinguish recent or long-term infected persons based on the maturation of the immune response. However, the development of HIV incidence assays has been challenging due to factors such as variability in immune responses at an individual and population level, variability by HIV-1 subtype, access to antiretroviral therapy, decreases in the genetic diversity of the HIV in the era of antiretroviral therapy, advanced HIV disease and other factors that are not well understood that can lead to misclassification of individuals [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Estimating HIV incidence in the Akwa Ibom AIDS indicator survey (AKAIS), Nigeria using the limiting antigen avidity recency assay

Negedu-Momoh¹,

Balogun²,

Dafa³

et al. 2021

J. Intern. AIDS Soc.

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Introduction HIV incidence estimates are important to characterize the status of an epidemic, identify locations and populations at high risk and to guide and evaluate HIV prevention interventions. We used the limiting antigen avidity assay (LAg) as part of a recent infection testing algorithm to estimate HIV incidence in the Akwa Ibom AIDS Indicator Survey (AKAIS), Nigeria. Methods In 2017, AKAIS, a cross‐sectional population‐based study was conducted at the household (HH) level in 31 local government areas (LGAs) of Akwa Ibom state. Of the 8963 participants aged ≥15 years who were administered questionnaires for demographic and behavioural data, 8306 consented to HIV rapid testing. Whole‐blood specimens were collected from 394 preliminary HIV‐seropositive individuals for CD4+ cell count determination and plasma storage. Samples were shipped to a central quality laboratory for HIV confirmatory testing and viral load determination. A total of 370 HIV‐positive specimens were tested for the recent HIV infection using the LAg assay. Results Of the 8306 consenting adults, the HIV prevalence was 4.8%. Of the 370 HIV‐positive samples tested for HIV recency, the median age was 35 years, 48.8% had CD4+ cell count >500/mm3 and 81.3% was not virally suppressed. Viral suppression was greater among females (21%) than for males (13%). A total of 11 specimens were classified as recent based on the LAg assay and HIV viral load ≥1000 copies/mL. The weighted, adjusted HIV‐1 incidence was 0.41/100 person‐years (95% CI 0.16 to 0.66); translating to 13,000 new cases of HIV infections annually in Akwa Ibom, a state with a population of 5.5 million. The HIV incidence rate was similar in females and males (0.41% and 0.42% respectively). The incidence rate was the highest among participants aged 15 to 49 years (0.44%, 95% CI 0.15 to 0.74) translating to 11,000 new infections annually, about 85% of all new infections in the state. Conclusions The finding of the high HIV incidence among the 15 to 49‐year age group calls for renewed and innovative efforts to prevent HIV infection among young adults in Akwa Ibom state.

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Section: Discussionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Estimating HIV incidence in the Akwa Ibom AIDS indicator survey (AKAIS), Nigeria using the limiting antigen avidity recency assay

Negedu-Momoh¹,

Balogun²,

Dafa³

et al. 2021

J. Intern. AIDS Soc.

View full text Add to dashboard Cite

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“…Because of a paucity of specimens that belong to subtypes other than those shown in Tables 1 and 2 in the panels used to calibrate the algorithm (i.e., determine the MDRI and FRR), surveys conducted in some regions of the world where such subtypes are prevalent will need to use an MDRI and FRR derived from much smaller data sets (e.g., CRF01_AE) 50 or estimated in the absence of complete calibration data (e.g., subtype F, G, CRF02_AG, or other CRFs). 69 For CRF01_AE, the published MDRI for the LAg assay was derived using slightly different methods than those shown in Table 1, and thus may not be directly comparable to these values; furthermore, an FRR for CRF01_AE was not reported. 50 However, the MDRI that has been calculated is very similar to the subtype B estimate (122 vs. 129 days), suggesting that using subtype B MDRI and FRR for CRF01_AE may be an acceptable approximation.…”

Section: Hiv-1 Subtype Diversitymentioning

confidence: 99%

Facilitating Next‐Generation Pre‐Exposure Prophylaxis Clinical Trials Using HIV Recent Infection Assays: A Consensus Statement from the Forum HIV Prevention Trial Design Project

Parkin

Gao

Grebe

et al. 2023

Clin Pharma and Therapeutics

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Standard‐of‐care HIV pre‐exposure prophylaxis (PrEP) is highly efficacious, but uptake of and persistence on a daily oral pill is low in many settings. Evaluation of alternate PrEP products will require innovation to avoid the unpractically large sample sizes in noninferiority trials. We propose estimating HIV incidence in people not on PrEP as an external counterfactual to which on‐PrEP incidence in trial subjects can be compared. HIV recent infection testing algorithms (RITAs), such as the limiting antigen avidity assay plus viral load used on specimens from untreated HIV positive people identified during screening, is one possible approach. Its feasibility is partly dependent on the sample size needed to ensure adequate power, which is impacted by RITA performance, the number of recent infections identified, the expected efficacy of the intervention, and other factors. Screening sample sizes to support detection of an 80% reduction in incidence for 3 key populations are more modest, and comparable to the number of participants in recent phase III PrEP trials. Sample sizes would be significantly larger in populations with lower incidence, where the false recency rate is higher or if PrEP efficacy is expected to be lower. Our proposed counterfactual approach appears to be feasible, offers high statistical power, and is nearly contemporaneous with the on‐PrEP population. It will be important to monitor the performance of this approach during new product development for HIV prevention. If successful, it could be a model for preventive HIV vaccines and prevention of other infectious diseases.

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“… 1 , 2 Point-of-care rapid testing for recent HIV infection (RTRI), which aims to detect HIV infection acquired within 12 months, has recently become available and is being scaled up under the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) to describe shifting dynamics in the HIV epidemic and to interrupt active HIV transmission networks. 3–6 To minimize the proportion false recent (PFR), viral load (VL) testing is used to confirm a recent infection as part of a recent infection testing algorithm (RITA), 7–10 but is not practiced in all PEPFAR programs in Africa, where the PFR can be high, 11 , 12 due to limits in the availability of VL testing.…”

Section: Introductionmentioning

confidence: 99%

Recent HIV Infection Among Men Who Have Sex with Men, Transgender Women, and Genderqueer Individuals with Newly Diagnosed HIV Infection in Zimbabwe: Results from a Respondent-Driven Sampling Survey

Parmley

Harris

Hakim

et al. 2022

AIDS Research and Human Retroviruses

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In Africa, rapid testing for recent HIV infection (RTRI) is being scaled up; however, use of the recent infection testing algorithm (RITA), which uses viral load (VL) to confirm RTRI-recent infections, is not a widespread practice. We present results of recently acquired HIV infections among men who have sex with men (MSM), transgender women, and genderqueer (TGW/GQ) individuals with newly diagnosed HIV infection in Zimbabwe as per the national approach (RTRI) and applying a RITA. In 2019, 1,538 MSM and TGW/GQ in Harare and Bulawayo, Zimbabwe were recruited to participate in a biobehavioral survey using respondent-driven sampling. Consenting participants received HIV testing and all HIV-positive specimens were tested with the RTRI Asanté HIV-1 Rapid Recency Assay, and for VL and CD4 count. RTRI-recent participants with unsuppressed VL (≥1,000 copies/mL) were classified as RITA-recent. Descriptive statistics were used to summarize results among RTRI-recent and RITA-recent participants. Among those tested for HIV (1,511/1,538), 22.5% (340/1,511) tested positive and of those, 55.0% (187/340) self-reported an HIV-negative or unknown status. Among these, 8.6% (16/187) were classified as RTRI-recent and 91.4% (171/187) were classified as RTRI-long term. After accounting for VL, RITA-recency was 1.1% (2/187). Two of 16 (12.5%) RTRI-recent infections were RITA-recent. VL among RITA-recent cases were 9,052 copies/mL and 40,694 copies/mL and both had CD4 counts <500. Data highlight misclassification of recent infections among MSM and TGW/GQ with newly diagnosed HIV infection using RTRI. With the incorporation of VL, >85% of RTRI-recent cases were reclassified as RITA-long term. True characterization of recent infections may not be possible without VL testing, which remains challenging in resource-limited settings.

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Short Communication: False Recent Ratio of the Limiting-Antigen Avidity Assay and Viral Load Testing Algorithm Among Cameroonians with Long-Term HIV Infection

Cited by 4 publications

References 10 publications

Estimating HIV incidence in the Akwa Ibom AIDS indicator survey (AKAIS), Nigeria using the limiting antigen avidity recency assay

Estimating HIV incidence in the Akwa Ibom AIDS indicator survey (AKAIS), Nigeria using the limiting antigen avidity recency assay

Facilitating Next‐Generation Pre‐Exposure Prophylaxis Clinical Trials Using HIV Recent Infection Assays: A Consensus Statement from the Forum HIV Prevention Trial Design Project

Recent HIV Infection Among Men Who Have Sex with Men, Transgender Women, and Genderqueer Individuals with Newly Diagnosed HIV Infection in Zimbabwe: Results from a Respondent-Driven Sampling Survey

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