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

Gous, Natasha; Scott, Lesley; Perovic, Olga; Venter, François; Stevens, Wendy

doi:10.1128/jcm.00702-10

Cited by 13 publications

(14 citation statements)

References 15 publications

(19 reference statements)

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“…In South Africa, the prevalence of HIV infection in the general population is almost 11% (35 ), but diagnosis of acute HIV infection is rare (36 ). Feasibility of NAT implementation in these very high-incidence settings (36,37 ) has highlighted both the epidemiological benefits and the challenges around adoption of these methods. A lowcost immunoassay with the sensitivity of NAT could represent an opportunity to further affect the spread of HIV in these settings.…”

Section: Discussionmentioning

confidence: 99%

Rapid, Fully Automated Digital Immunoassay for p24 Protein with the Sensitivity of Nucleic Acid Amplification for Detecting Acute HIV Infection

et al. 2015

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BACKGROUND: Nucleic acid testing (NAT) has become the standard for high sensitivity in detecting low levels of virus. However, adoption of NAT can be cost prohibitive in low-resource settings where access to extreme sensitivity could be clinically advantageous for early detection of infection. We report development and preliminary validation of a simple, low-cost, fully automated digital p24 antigen immunoassay with the sensitivity of quantitative NAT viral load (NAT-VL) methods for detection of acute HIV infection.

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Section: Discussionmentioning

confidence: 99%

Rapid, Fully Automated Digital Immunoassay for p24 Protein with the Sensitivity of Nucleic Acid Amplification for Detecting Acute HIV Infection

et al. 2015

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“…Many updated HIV testing algorithms combine 3 rd and/or 4 th generation assays with more sensitive nucleic acid testing (NAT) technologies [12,67]. NAT has been used successfully for AHI screening in LMICs, even using finger stick specimens [32,69,[77][78][79][80][81][82][83][84][85]. However, in large part due to the resource and logistical limitations, there have been no NAT or 4 th generation assay programmes integrated as routine practice in LMICs.…”

Section: Diagnostic Algorithms For Ahimentioning

confidence: 99%

Clinical and public health implications of acute and early HIV detection and treatment: a scoping review

Rutstein

Ananworanich

Fidler

et al. 2017

Journal of the International AIDS Society

118

140

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Introduction: The unchanged global HIV incidence may be related to ignoring acute HIV infection (AHI). This scoping review examines diagnostic, clinical, and public health implications of identifying and treating persons with AHI.Methods: We searched PubMed, in addition to hand-review of key journals identifying research pertaining to AHI detection and treatment. We focused on the relative contribution of AHI to transmission and the diagnostic, clinical, and public health implications. We prioritized research from low- and middle-income countries (LMICs) published in the last fifteen years.Results and Discussion: Extensive AHI research and limited routine AHI detection and treatment have begun in LMIC. Diagnostic challenges include ease-of-use, suitability for application and distribution in LMIC, and throughput for high-volume testing. Risk score algorithms have been used in LMIC to screen for AHI among individuals with behavioural and clinical characteristics more often associated with AHI. However, algorithms have not been implemented outside research settings. From a clinical perspective, there are substantial immunological and virological benefits to identifying and treating persons with AHI – evading the irreversible damage to host immune systems and seeding of viral reservoirs that occurs during untreated acute infection. The therapeutic benefits require rapid initiation of antiretrovirals, a logistical challenge in the absence of point-of-care testing. From a public health perspective, AHI diagnosis and treatment is critical to: decrease transmission via viral load reduction and behavioural interventions; improve pre-exposure prophylaxis outcomes by avoiding treatment initiation for HIV-seronegative persons with AHI; and, enhance partner services via notification for persons recently exposed or likely transmitting.Conclusions: There are undeniable clinical and public health benefits to AHI detection and treatment, but also substantial diagnostic and logistical barriers to implementation and scale-up. Effective early ART initiation may be critical for HIV eradication efforts, but widespread use in LMIC requires simple and accurate diagnostic tools. Implementation research is critical to facilitate sustainable integration of AHI detection and treatment into existing health systems and will be essential for prospective evaluation of testing algorithms, point-of-care diagnostics, and efficacious and effective first-line regimens.

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“…but constitutes a substantial proportion of new HIV diagnoses, especially in high-risk individuals [46,[52][53][54][55][56][57][58][59][60][61].…”

Section: Key Issuesmentioning

confidence: 99%

Diagnosing acute HIV infection

Yerly

Hirschel

2012

Expert Review of Anti-infective Therapy

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Individuals with acute HIV infection (AHI) pose a greater transmission risk than most chronically HIV-infected patients and prevention efforts targeting these individuals are important for reducing the spread of HIV infection. Rapid and accurate diagnosis of AHI is crucial. Since symptoms of AHI are nonspecific, its diagnosis requires a high index of suspicion and appropriate HIV laboratory tests. However, even 30 years after the start of the HIV epidemic, laboratory tools remain imperfect and only a few individuals with AHI are identified. We review the clinical presentation of the acute retroviral syndrome, the laboratory markers and their detection methods, and propose an algorithm for the laboratory diagnosis of AHI.

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

Cited by 13 publications

References 15 publications

Rapid, Fully Automated Digital Immunoassay for p24 Protein with the Sensitivity of Nucleic Acid Amplification for Detecting Acute HIV Infection

Rapid, Fully Automated Digital Immunoassay for p24 Protein with the Sensitivity of Nucleic Acid Amplification for Detecting Acute HIV Infection

Clinical and public health implications of acute and early HIV detection and treatment: a scoping review

Diagnosing acute HIV infection

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