1. HIV-1 Recent Infection Testing Algorithm With Antiretroviral Drug Detection to Improve Accuracy of Incidence Estimates
- Author
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Frehywot Eshetu, Hetal Patel, Ernest L. Yufenyuy, Assegid Mengistu, Yohannes Mengistu, Andrew C. Voetsch, Paul Stupp, Kristin Brown, Owen Mugurungi, Daniel B Williams, Godfrey Musuka, Fred Asiimwe, Munyaradzi Pasipamire, Emily Kainne Dokubo, John N Kiiru, Mervi Detorio, Stephen McCracken, Prisca Chikwanda, Roger Lobognon, Dorothy Aibo, Andrew Kabala, George S Mgomella, Sam Biraro, Clement B. Ndongmo, Shirish Balachandra, Sindisiwe Dlamini, Bharat Parekh, Optatus Malewo, Jennifer Ward, Anne-Cécile Zoung-Kanyi Bissek, Harriet Nuwagaba-Biribonwoha, Elizabeth Kampira, Belete Tegbaru, Laura T. Eno, Judith Shang, Frieda S Winterhalter, Muthoni Junghae, Yen T Duong, Richard C N Mwesigwa, Trudy Dobbs, Leonard Kingwara, Jeremiah Mushi, Suzue Saito, and Danielle Payne
- Subjects
Adult ,Male ,Adolescent ,Anti-HIV Agents ,Human immunodeficiency virus (HIV) ,HIV Infections ,Antiretroviral drug ,Drug resistance ,030312 virology ,Optical density ,medicine.disease_cause ,Article ,Young Adult ,03 medical and health sciences ,Clinical history ,medicine ,Humans ,Pharmacology (medical) ,0303 health sciences ,business.industry ,Incidence ,Incidence (epidemiology) ,virus diseases ,Limiting ,Middle Aged ,Infectious Diseases ,Epidemiological Monitoring ,HIV-1 ,Female ,business ,Algorithm ,Viral load ,Algorithms - Abstract
Background HIV-1 incidence calculation currently includes recency classification by HIV-1 incidence assay and unsuppressed viral load (VL ≥ 1000 copies/mL) in a recent infection testing algorithm (RITA). However, persons with recent classification not virally suppressed and taking antiretroviral (ARV) medication may be misclassified. Setting We used data from 13 African household surveys to describe the impact of an ARV-adjusted RITA on HIV-1 incidence estimates. Methods HIV-seropositive samples were tested for recency using the HIV-1 Limiting Antigen (LAg)-Avidity enzyme immunoassay, HIV-1 viral load, ARVs used in each country, and ARV drug resistance. LAg-recent result was defined as normalized optical density values ≤1.5. We compared HIV-1 incidence estimates using 2 RITA: RITA1: LAg-recent + VL ≥ 1000 copies/mL and RITA2: RITA1 + undetectable ARV. We explored RITA2 with self-reported ARV use and with clinical history. Results Overall, 357 adult HIV-positive participants were classified as having recent infection with RITA1. RITA2 reclassified 55 (15.4%) persons with detectable ARV as having long-term infection. Those with detectable ARV were significantly more likely to be aware of their HIV-positive status (84% vs. 10%) and had higher levels of drug resistance (74% vs. 26%) than those without detectable ARV. RITA2 incidence was lower than RITA1 incidence (range, 0%-30% decrease), resulting in decreased estimated new infections from 390,000 to 341,000 across the 13 countries. Incidence estimates were similar using detectable or self-reported ARV (R2 > 0.995). Conclusions Including ARV in RITA2 improved the accuracy of HIV-1 incidence estimates by removing participants with likely long-term HIV infection.
- Published
- 2021
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