scholarly journals Do I Have HIV or Not? Lack of RNA Detection and the Case for Sensitive DNA Testing

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Sandra A Springer ◽  
Silvina Masciotra ◽  
Jeffrey A Johnson ◽  
Sheldon Campbell
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Viral Rna ◽  
Infection Status ◽  
Test Results ◽  
Dna Testing ◽  
Rna Detection ◽  
Hiv Test

Abstract We present a case of a 20-year-old male who had ambiguous HIV test results after entering new provider care and whose status was later complicated by undetectable viral RNA off antiretroviral therapy (ART). Verifying HIV infection status may occasionally require sensitive DNA testing that might need to be considered in diagnostic guidelines to resolve diagnosis and ensure appropriate ART management.

scholarly journals Decreased Seroreactivity in Individuals Initiating Antiretroviral Therapy during Acute HIV Infection

2019 ◽  
Vol 57 (10) ◽  
Author(s):  
Mark M. Manak ◽  
Linda L. Jagodzinski ◽  
Ashley Shutt ◽  
Jennifer A. Malia ◽  
Mike Leos ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Western Blot ◽  
Research Collaboration ◽  
Virologic Suppression ◽  
Infection Status ◽  
Acute Hiv Infection ◽  
Western Blot Assay ◽  
Acute Hiv ◽  
Hiv 1

ABSTRACTAntiretroviral therapy (ART) during acute HIV infection (AHI) interrupts viral dynamics and may delay the emergence of serological markers targeted by current HIV screening and confirmatory assays, thus creating challenges for correctly classifying HIV infection status. The performance of three HIV antigen/antibody combination (HIV Ag/Ab Combo) assays (the Bio-Rad GS, Abbott Architect, and Bio-Rad BioPlex 2200 assays) was evaluated with samples collected from RV254/South East Asia Research Collaboration in HIV 010 (RV254/SEARCH010) study (Bangkok, Thailand) participants at weeks 12 and 24 following the initiation of ART at Fiebig stage I (FI) (n = 23), FII (n = 39), or FIII/IV (n = 22). Supplemental, confirmatory testing was performed by the Geenius HIV 1/2 and HIV-1 Western blot assays (Bio-Rad). Samples from 30 untreated, HIV-1-infected individuals demonstrated robust HIV Ag/Ab Combo assay reactivity with well-developed HIV-1 Western blotting profiles by 24 weeks after infection. In contrast, 52.2% of samples from individuals initiating ART at FI, 7.7% of samples from individuals initiating ART at FII, and 4.5% of samples from individuals initiating ART at FIII/IV were nonreactive by the HIV Ag/Ab Combo assays, with 36.4 to 39.1% of samples having low signal-to-cutoff (S/CO) results by the Architect and BioPlex assays (S/CO < 10). Seroreversion from a reactive to a nonreactive status was observed in 10 individuals initiating ART at FII and 3 individuals initiating ART at FIII/IV. The Geenius and HIV-1 Western blot assay results were negative or indeterminate for 73.9% and 69.6% of individuals, respectively, treated at FI; 50.0% and 26.3% of individuals, respectively, treated at FII; and 54.5% and 40.9% of individuals, respectively, treated at FIII/IV. Virologic suppression of HIV-1 by ART during AHI impedes seroconversion to biomarkers of infection, limiting the utility of HIV Ag/Ab Combo and supplemental, confirmatory assays for infection status determination.

scholarly journals Prospective Evaluation of HIV Testing Technologies in a Clinical Setting: Protocol for Project DETECT (Preprint)

2019 ◽  
Author(s):  
Joanne D Stekler ◽  
Lauren R Violette ◽  
Hollie A Clark ◽  
Sarah J McDougal ◽  
Lisa A Niemann ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Prospective Study ◽  
Hiv Testing ◽  
Transmitted Disease ◽  
The United States ◽  
Test Results ◽  
Cross Sectional ◽  
Hiv Test ◽  
Hiv Acquisition ◽  
Hiv 1

BACKGROUND HIV testing guidelines provided by the Centers for Disease Control and Prevention (CDC) are continually changing to reflect advancements in new testing technology. Evaluation of existing and new point-of-care (POC) HIV tests is crucial to inform testing guidelines and provide information to clinicians and other HIV test providers. Characterizing the performance of POC HIV tests using unprocessed specimens can provide estimates for the window period of detection, or the time from HIV acquisition to test positivity, which allows clinicians and other HIV providers to select the appropriate POC HIV tests for persons who may be recently infected with HIV. OBJECTIVE This paper describes the protocols and procedures used to evaluate the performance of the newest POC tests and determine their sensitivity during early HIV infection. METHODS Project DETECT is a CDC-funded study that is evaluating POC HIV test performance. Part 1 is a cross-sectional, retrospective study comparing behavioral characteristics and HIV prevalence of the overall population of the Public Health–Seattle &amp; King County (PHSKC) Sexually Transmitted Disease (STD) Clinic to Project DETECT participants enrolled in part 2. Part 2 is a cross-sectional, prospective study evaluating POC HIV tests in real time using unprocessed whole blood and oral fluid specimens. A POC nucleic acid test (NAT) was added to the panel of HIV tests in June 2018. Part 3 is a longitudinal, prospective study evaluating seroconversion sensitivity of POC HIV tests through serial follow-up testing. For comparison, HIV-1 RNA and HIV-1/HIV-2 antigen/antibody tests are also performed for participants enrolled in part 2 or 3. A behavioral survey that collects information about demographics, history of HIV testing, STD history, symptoms of acute HIV infection, substance use, sexual behaviors in the aggregate and with recent partners, and use of pre-exposure prophylaxis and antiretroviral therapy is completed at each part 2 or 3 visit. RESULTS Between September 2015 and March 2019, there were 14,990 Project DETECT–eligible visits (part 1) to the PHSKC STD Clinic resulting in 1819 part 2 Project DETECT study visits. The longitudinal study within Project DETECT (part 3) enrolled 27 participants with discordant POC test results from their part 2 visit, and 10 (37%) were followed until they had fully seroconverted with concordant positive POC test results. Behavioral survey data and HIV test results, sensitivity, and specificity will be presented elsewhere. CONCLUSIONS Studies such as Project DETECT are critical for evaluating POC HIV test devices as well as describing characteristics of persons at risk for HIV acquisition in the United States. HIV tests in development, including POC NATs, will provide new opportunities for HIV testing programs. INTERNATIONAL REGISTERED REPORT RR1-10.2196/16332

scholarly journals Gender variation in self-reported likelihood of HIV infection in comparison with HIV test results in rural and urban Nigeria

2011 ◽  
Vol 8 (1) ◽  
pp. 44 ◽  
Author(s):  
Adeniyi F Fagbamigbe ◽  
Joshua O Akinyemi ◽  
Babatunde O Adedokun ◽  
Elijah A Bamgboye
Keyword(s):  
Hiv Infection ◽  
Test Results ◽  
Gender Variation ◽  
Rural And Urban ◽  
Hiv Test

scholarly journals Absence of routine molecular testing and prevalence of HIV-2 infection in regions hardest-hit by HIV infection

2012 ◽  
Vol 6 (12) ◽  
pp. 854-859 ◽  
Author(s):  
Joseph C Forbi ◽  
Mathew D Esona ◽  
Hellen O Iperepolu ◽  
Moses P Adoga ◽  
Simon M Agwale
Keyword(s):  
Hiv Infection ◽  
Sex Workers ◽  
False Negative ◽  
Rapid Test ◽  
Molecular Testing ◽  
Test Results ◽  
Active Population ◽  
Hiv Test ◽  
In Series ◽  
Hiv 1

Introduction: Investigating the incidence and dynamics of HIV-2 and false-negative HIV test results in a highly sexually active population where frequent opportunities exist for acquiring and transmitting infections provides additional understanding of the epidemiology of the virus in Africa. Methodology: The HIV status of 900 active female sex workers (FSWs) was determined using two lateral flow rapid assays in series. The second rapid test device incorporates type-specific recombinant peptides that discriminate between HIV-1 and HIV-2 infection. HIV sero-negative samples were re-tested for HIV infection and their viral loads determined using the NucliSENS real-time nucleic acid sequence-based amplification (NASBA) platform. Results: In total, 335 FSWs were determined to be HIV positive, the majority (227; 67.8%) of whom were between the ages of 20 and 30 years. Eighteen (5.4%) were found to have evidence of HIV-2 infection, 17 of whom were co-infected with HIV-1. Only one HIV-2 mono-infection was observed. Out of 565 HIV-negative individuals determined by serology, 11(1.9%; p>0.05) were found to be HIV-1 positive when tested via the NASBA platform. Conclusion: False negative test results, HIV-2 infection, and complex transmission networks among FSWs may aid in fueling the HIV epidemic in the Nigerian population. These findings demonstrate the need to reevaluate the quality of HIV serological diagnostics, control services, and stress the need for widespread introduction of molecular testing among high-risk populations in the country.

Fulminant diffuse cerebral toxoplasmosis as the first manifestation of HIV infection

2021 ◽  
Vol 14 (1) ◽  
pp. e237120
Author(s):  
Louise Dunphy ◽  
Bret Palmer ◽  
Fabian Chen ◽  
Joanne Kitchen
Keyword(s):  
Emergency Department ◽  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Cd4 Count ◽  
Sub Saharan Africa ◽  
Cerebral Toxoplasmosis ◽  
Hiv Test ◽  
Ct Head ◽  
Tenofovir Alafenamide ◽  
Multiple Ring

Individuals with HIV may present to the emergency department with HIV-related or HIV-unrelated conditions, toxicity associated with antiretroviral therapy or primary HIV infection (seroconversion). In individuals with HIV infection, central nervous system toxoplasmosis occurs from reactivation of disease, especially when the CD4+ count is <100 cells/μL, whereas in those taking immunosuppressive therapy, this can be either due to newly acquired or reactivated latent infection. It is a rare occurrence in immune-competent patients. Vertical transmission during pregnancy can manifest as congenital toxoplasmosis in the neonate and is often asymptomatic until the second or third decade of life when ocular lesions develop. Toxoplasmosis is an infection caused by the intracellular protozoan parasite Toxoplasma gondii and causes zoonotic infection. It can cause focal or disseminated brain lesions leading to neurological deficit, coma and death. Typical radiological findings are multiple ring-enhancing lesions. Histopathological examination demonstrating tachyzoites of T. gondii and the presence of nucleic material in the spinal cerebrospinal fluid (CSF) confirms the diagnosis. The authors present the case of a 52-year-old male UK resident, born in sub-Saharan Africa, with a 3-week history of visual hallucinations. He attended the emergency department on three occasions. Laboratory investigations and a CT head were unremarkable. He was referred to psychological medicine for further evaluation. On his third presentation, 2 months later, a CT head showed widespread lesions suggestive of cerebral metastasis. Dexamethasone was initiated and he developed rigours. An MRI head showed multiple ring-enhancing lesions disseminated throughout his brain parenchyma. CSF analysis and serology confirmed the diagnosis of HIV and toxoplasmosis, respectively. His CD4 count was 10 and his viral load (VL) was 1 245 003. He was then initiated on Biktarvy 50 mg/200 mg/25 mg, one tablet daily, which contains 50 mg of bictegravir, 200 mg of emtricitabine and tenofovir alafenamide fumarate equivalent to 25 mg of tenofovir alafenamide. After 3 months of antiretroviral therapy, his HIV VL reduced to 42. However, his abbreviated mental test remained at 2/10. Despite presenting with neurocognitive impairment and being born in a HIV prevalent region, an HIV test was not offered. This case highlights missed opportunities to request HIV serology and raises awareness that cerebral toxoplasmosis can occur as the first manifestation of HIV. Prompt diagnosis and early initiation of antiretroviral therapy reduces morbidity and mortality in this patient cohort.

scholarly journals A Strategy for PrEP Clinicians to Manage Ambiguous HIV Test Results During Follow-up Visits

2018 ◽  
Vol 5 (8) ◽  
Author(s):  
Dawn K Smith ◽  
William M Switzer ◽  
Philip Peters ◽  
Kevin P Delaney ◽  
Timothy C Granade ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Test Results ◽  
Hiv Status ◽  
Management Options ◽  
Hiv Test ◽  
Confirmatory Tests ◽  
Testing Algorithms ◽  
Effective Treatment Regimen ◽  
Exposure Prophylaxis

Abstract Prompt determination of HIV infection status is critical during follow-up visits for patients taking pre-exposure prophylaxis (PrEP) medication. Those who are uninfected can then continue safely taking PrEP, and those few who have acquired HIV infection can initiate an effective treatment regimen. However, a few recent cases have been reported of ambiguous HIV test results using common testing algorithms in PrEP patients. We review published reports of such cases and testing options that can be used to clarify true HIV status in these situations. In addition, we review the benefits and risks of 3 antiretroviral management options in these patients: (1) continue PrEP while conducting additional HIV tests, (2) initiate antiretroviral therapy for presumptive HIV infection while conducting confirmatory tests, or (3) discontinue PrEP to reassess HIV status after a brief antiretroviral-free interval. A clinical consultation resource is also provided.

scholarly journals DEPENDENCE OF DETECTION OF MARKERS OF OPPORTUNISTIC INFECTIONS FROM ADHERENCE TO ANTIRETROVIRAL THERAPY IN CHILDREN BORN BY HIV-INFECTED MATTERS

2018 ◽  
pp. 76-81
Author(s):  
T. N. Rybalkina ◽  
N. V. Karazhas ◽  
P. A. Savinkov ◽  
R. E. Boshyan ◽  
M. Yu. Lysenkova ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Blood Cells ◽  
Opportunistic Infections ◽  
Social Institutions ◽  
Culture Method ◽  
Hiv Positive ◽  
Chemotherapy Drugs ◽  
Hiv Test ◽  
Full Volume

Aim. To study the dependence of detection of markers of opportunistic infections from afherence to antiretroviral therapy in children born to HIV-infected mothers on the example of herpesvirus infectionsand pneumocystis. Materials and methods. Samples of biological materials (blood serum and blood cells) of 66 children with HIV infection aged 1 month to 15 years old were treated in Children’s Boxed Department of Children’s Hospital No. 2 with diagnoses «incomplete HIV test» (children from the age of one month to one and a half years) and «HIV infection». To determine IgM and IgG to herpesviruses and pneumocyst, the method of enzyme immunoassay was used; indirect immunofluorescence reaction for the detection of herpesviruses and their antigens in the blood, early antigens and virus reproduction were determined using a rapid culture method. Results. 56.0% of the surveyed children received complete antiretroviral therapy, in 16,7% of cases they were not complete, and 27,3% of children did not fully adhere to ARVT. Despite the fact that 100% of children with an incomplete diagnosis of HIV infection were covered by ARVT due to the use of chemotherapy drugs by their mothers during pregnancy, they still had markers of both active and latent forms of herpesvirus infections and pneumocystis. In children with confirmed HIV infection living both in social institutions and in families, the markers of opportunistic infections were more often diagnosed in patients receiving ARVT in full and not in full volume than in children who did not have it. Conclusion. Identification of markers of active forms of herpesvirus infections and pneumocystis in HIV-positive children not receiving ARV is the basis for its immediate appointment.

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