title: Improved detection of serum HIV p24 antigen after acid dissociation of immune complexes.
abstract: OBJECTIVE
  To evaluate an acid pretreatment method designed to dissociate HIV p24 antigen from immune complexes in serum.
  
  
  METHODS
  Patient sera and sera containing experimental immune complexes were quantified for p24 antigen before and after immune complex dissociation (ICD). The clinical application of ICD was assessed in 1328 serum and plasma samples collected from HIV-infected patients.
  
  
  METHODS
  Immune complexes were created artificially by mixing purified p24 antigen with antibody-positive sera or a standardized concentration of human antibody to p24. ICD was achieved by incubation of samples with an equal volume of Glycine HCl for 90 min at 37 degrees C followed by neutralization with Tris NaOH. Samples were quantified for p24 antigen using a commercial enzyme-linked immunosorbent assay (ELISA) kit.
  
  
  RESULTS
  ICD resulted in significant release of purified antigen from simulated immune complexes in antibody-positive sera. Variation in antigen sequestration and dissociation was related to anti-gag antibody titers. ICD resulted in complete recovery of 500 pg of antigen complexed with human anti-p24 antibody at concentrations up to 2.5 U/ml. In seropositive patients, the mean level of serum antigen was 3.5-fold higher after ICD, and an additional 21% were antigen-positive.
  
  
  CONCLUSIONS
  Pretreatment greatly improved antigen detection in HIV-antibody-positive sera by effectively dissociating immune complexes without compromising reactivity of the antigen itself. The treatment also facilitated routine monitoring of patients by revealing fluctuations in serum antigen that were indistinguishable or poorly defined in untreated sera.
authors.affiliation: Laboratory of Virology, AIDS Centre San Luigi, Hospital San Raffaele IRCCS, Milan, Italy.
authors.forename: F B
authors.initials: FB
authors.lastname: Lillo
authors.forename: Y
authors.initials: Y
authors.lastname: Cao
authors.forename: D R
authors.initials: DR
authors.lastname: Concedi
authors.forename: O E
authors.initials: OE
authors.lastname: Varnier
mesh_terms: D000936:Antigen-Antibody Complex / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D005069:Evaluation Studies as Topic; D016655:HIV Core Protein p24 / Q000097:blood*; D006801:Humans; D006863:Hydrogen-Ion Concentration
chemical_list: D000936:Antigen-Antibody Complex; D016655:HIV Core Protein p24