The Impact of Early Antiretroviral Treatment (ART) for HIV on the Sensitivity of the Latest Generation of Blood Screening and Point of Care Assays

Abstract

Introduction: Rapid initiation of antiretroviral therapy (ART) in early HIV infection is important to limit seeding of the viral reservoir. A number of studies have shown that if ART is commenced prior to seroconversion, the seroconversion may, or may not, occur. We aimed to assess whether seroreversion or no seroconversion occurs using samples collected during an early treatment study in South Africa. Methods: We tested 10 longitudinal samples collected over three years from 70 blood donors who initiated ART after detection of acute or early HIV infection during donation screening on fourth- and fifth-generation HIV antibody and RNA assays, and three point of care (POC) rapid tests. Donors were allocated to three treatment groups: (1) very early, (2) early, and (3) later. Longitudinal samples were grouped into time bins post-treatment initiation. Results: On all three high-throughput HIV antibody assays, no clear pattern of declining signal intensity was observed over time after ART initiation in any of the treatment initiation groups and 100% detection was obtained. The Abbott Determine POC assay showed 100% detection at all time points with no seroreversion. However, the Abbott ABON HIV1 and OraSure OraQuick POC assays showed lower proportions of detection in all time bins in the very early treated group, ranging from 50.0% (95% CI: 26.8–73.2%) to 83.1% (95% CI: 64.2–93.0%), and moderate detection rates in the early and later-treated groups. Conclusion: While our findings are generally reassuring for HIV detection when high-throughput serological screening assays are used, POC assays may have lower sensitivity for detection of HIV infection after early treatment. Findings are relevant for blood safety and other settings where POC assays are used.

Analysis of ART effects and drug resistance in adult HIV/AIDS patients in Meigu County, Liangshan Prefecture, China

“…High CD4 + counts and high viral load suppression make ART more likely to be successful [ 5 ], and the initiation of antiviral therapy in patients with CD4 + counts above 500 cells/μl significantly reduces the combined endpoint events of mortality and morbidity [ 5 , 6 ] and reduces the risk of drug resistance [ 7 ], reduced CD4 + counts, impaired cellular immune function, and immunity. The more severe the deficiency, the longer the required immune reconstitution takes and the higher the failure rate of ART, based on which it is recommended that ART be initiated rapidly in patients with HIV/AIDS [ 8 , 9 ].…”

HIV screening among prospective blood donors who are negative for conventional screening methods in referral hospitals in Kebbi State Nigeria

“…The absence of HIV infection among the prospective blood donors using the WHO-recommended two-test diagnostic technique (the conventional rapid test and the p24 antigen ELISA) raised confidence in the specificity of the blood before transfusion. Misdiagnosis of HIV can cause mental illness and public health repercussions and should thus be avoided to the extent possible [9,10,24]. Knowledge, practices, and risk studies are valuable tools deployed to assess the extent to which individuals adopt risk-free behaviours.…”

“…HIV/AIDS control depends on an accurate laboratory HIV infection diagnosis [9,10]. Rapid HIV-1/2 antibody-based point-of-care (POC) tests are evolving and making HIV testing feasible in the developing world [10].…”

“…HIV/AIDS control depends on an accurate laboratory HIV infection diagnosis [9,10]. Rapid HIV-1/2 antibody-based point-of-care (POC) tests are evolving and making HIV testing feasible in the developing world [10]. Despite this, screening techniques can produce false-negative results for acute HIV infection and false-positive results for HIV vaccine recipients who are not sick and newborns who have passive maternal antibodies produced by mothers who are HIV-positive [11,12].…”

Viruses Special Issue “Transfusion-Transmitted Viral Infections”

“…If collected and transfused, such blood can transmit small amounts of potentially infectious virions to the recipient. Vermeulen and colleagues [ 9 ] addressed this concern in regard to South African blood donors and concluded that donors on ART may constitute a HIV transmission risk when relying on less sensitive serological rapid tests for screening, as is frequently the case in resource-limited countries. Although the risk appears to be extremely low when using the latest generation of high-throughput serological tests, further studies are required to monitor this emerging risk to blood safety.…”