title: Inaccurate diagnosis of HIV-1 group M and O is a key challenge for ongoing universal access to antiretroviral treatment and HIV prevention in Cameroon.
abstract: BACKGROUND
  Increased access to HIV testing is essential in working towards universal access to HIV prevention and treatment in resource-limited countries. We here evaluated currently used HIV diagnostic tests and algorithms in Cameroon for their ability to correctly identify HIV infections.
  
  
  METHODS
  We estimated sensitivity, specificity, and positive and negative predictive values of 5 rapid/simple tests, of which 3 were used by the national program, and 2 fourth generation ELISAs. The reference panel included 500 locally collected samples; 187 HIV -1 M, 10 HIV-1 O, 259 HIV negative and 44 HIV indeterminate plasmas.
  
  
  RESULTS
  None of the 5 rapid assays and only 1 ELISA reached the current WHO/UNAIDS recommendations on performance of HIV tests of at least 99% sensitivity and 98% specificity. Overall, sensitivities ranged between 94.1% and 100%, while specificities were 88.0% to 98.8%. The combination of all assays generated up to 9% of samples with indeterminate HIV status, because they reacted discordantly with at least one of the different tests. Including HIV indeterminate samples in test efficiency calculations significantly decreased specificities to a range from 77.9% to 98.0%. Finally, two rapid assays failed to detect all HIV-1 group O variants tested, with one rapid test detecting only 2 out of 10 group O specimens.
  
  
  CONCLUSIONS
  In the era of ART scaling-up in Africa, significant proportions of false positive but also false negative results are still observed with HIV screening tests commonly used in Africa, resulting in inadequate treatment and prevention strategies. Depending on tests or algorithms used, up to 6% of HIV-1 M and 80% of HIV-1 O infected patients in Cameroon do not receive ART and adequate counseling to prevent further transmission due to low sensitivities. Also, the use of tests with low specificities could imply inclusion of up to 12% HIV negative people in ART programs and increase budgets in addition to inconveniences caused to patients.
authors.affiliation: Virology Laboratory IMPM/IRD, Yaoundé, Cameroon. aghokeng@ird.fr
authors.forename: Avelin F
authors.initials: AF
authors.lastname: Aghokeng
authors.forename: Eitel
authors.initials: E
authors.lastname: Mpoudi-Ngole
authors.forename: Henriette
authors.initials: H
authors.lastname: Dimodi
authors.forename: Arrah
authors.initials: A
authors.lastname: Atem-Tambe
authors.forename: Marcel
authors.initials: M
authors.lastname: Tongo
authors.forename: Christelle
authors.initials: C
authors.lastname: Butel
authors.forename: Eric
authors.initials: E
authors.lastname: Delaporte
authors.forename: Martine
authors.initials: M
authors.lastname: Peeters
mesh_terms: D015492:AIDS Serodiagnosis / Q000295:instrumentation* / Q000379:methods; D000465:Algorithms; D044966:Anti-Retroviral Agents / Q000494:pharmacology*; D002163:Cameroon; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D005188:False Negative Reactions; D005189:False Positive Reactions; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy / Q000821:virology*; D015497:HIV-1 / Q000235:genetics* / Q000276:immunology; D006801:Humans; D008403:Mass Screening / Q000295:instrumentation / Q000379:methods; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D011933:Reagent Kits, Diagnostic; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D044966:Anti-Retroviral Agents; D011933:Reagent Kits, Diagnostic