Grant-McAuley, Wendy; Laeyendecker, Oliver; Monaco, Daniel; Chen, Athena; Hudelson, Sarah E; Klock, Ethan; Brookmeyer, Ron; Morrison, Douglas; Piwowar-Manning, Estelle; Morrison, Charles S; +11 more... Hayes, Richard; Ayles, Helen; Bock, Peter; Kosloff, Barry; Shanaube, Kwame; Mandla, Nomtha; van Deventer, Anneen; Ruczinski, Ingo; Kammers, Kai; Larman, H Benjamin; Eshleman, Susan H; (2022) Evaluation of multi-assay algorithms for cross-sectional HIV incidence estimation in settings with universal antiretroviral treatment. BMC infectious diseases, 22 (838). ISSN 1471-2334 DOI: https://doi.org/10.1186/s12879-022-07850-0
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Abstract
BACKGROUND: Multi-assay algorithms (MAAs) are used to estimate population-level HIV incidence and identify individuals with recent infection. Many MAAs use low viral load (VL) as a biomarker for long-term infection. This could impact incidence estimates in settings with high rates of early HIV treatment initiation. We evaluated the performance of two MAAs that do not include VL. METHODS: Samples were collected from 219 seroconverters (infected < 1 year) and 4376 non-seroconverters (infected > 1 year) in the HPTN 071 (PopART) trial; 28.8% of seroconverter samples and 73.2% of non-seroconverter samples had VLs ≤ 400 copies/mL. Samples were tested with the Limiting Antigen Avidity assay (LAg) and JHU BioRad-Avidity assays. Antibody reactivity to two HIV peptides was measured using the MSD U-PLEX assay. Two MAAs were evaluated that do not include VL: a MAA that includes the LAg-Avidity assay and BioRad-Avidity assay (LAg + BR) and a MAA that includes the LAg-Avidity assay and two peptide biomarkers (LAg + PepPair). Performance of these MAAs was compared to a widely used MAA that includes LAg and VL (LAg + VL). RESULTS: The incidence estimate for LAg + VL (1.29%, 95% CI: 0.97-1.62) was close to the observed longitudinal incidence (1.34% 95% CI: 1.17-1.53). The incidence estimates for the other two MAAs were higher (LAg + BR: 2.56%, 95% CI 2.01-3.11; LAg + PepPair: 2.84%, 95% CI: 1.36-4.32). LAg + BR and LAg + PepPair also misclassified more individuals infected > 2 years as recently infected than LAg + VL (1.2% [42/3483 and 1.5% [51/3483], respectively, vs. 0.2% [6/3483]). LAg + BR classified more seroconverters as recently infected than LAg + VL or LAg + PepPair (80 vs. 58 and 50, respectively) and identified ~ 25% of virally suppressed seroconverters as recently infected. CONCLUSIONS: The LAg + VL MAA produced a cross-sectional incidence estimate that was closer to the longitudinal estimate than two MAAs that did not include VL. The LAg + BR MAA classified the greatest number of individual seroconverters as recently infected but had a higher false recent rate.
Item Type | Article |
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Faculty and Department |
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology Faculty of Infectious and Tropical Diseases > Dept of Clinical Research |
PubMed ID | 36368950 |
Elements ID | 196726 |
Official URL | http://dx.doi.org/10.1186/s12879-022-07850-0 |
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Filename: Grant0McAuley-etal-2022-Evaluation-of-multi-assay-algorithms-for-cross-sectional-HIV-incidence-estimation-in-settings-with-universal-antiretroviral-treatment.pdf
Licence: Creative Commons: Attribution 4.0
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