title: Differential specificity of HIV incidence assays in HIV subtypes A and D-infected individuals from Rakai, Uganda.
abstract: Assays to determine HIV incidence from cross-sectional surveys have exhibited a high rate of false-recent misclassification in Kenya and Uganda where HIV subtypes A and D predominate. Samples from individuals infected with HIV for at least 2 years with known infecting subtype (133 subtype A, 373 subtype D) were tested using the BED-CEIA and an avidity assay. Both assays had a higher rate of false-recent misclassification for subtype D compared to subtype A (13.7% vs. 6.0%, p=0.02 for BED-CEIA; 11.0% vs. 1.5%, p<0.001 for avidity). For subtype D samples, false-recent misclassification by the BED-CEIA was also more frequent in women than men (15.0% vs. 5.6%, p=0.002), and for samples where that had an amino acid other than lysine at position 12 in the BED-CEIA peptide coding region (p=0.002). Furthermore in subtype D-infected individuals, samples misclassified by one assay were 3.5 times more likely to be misclassified by the other assay. Differential misclassification by infecting subtype of long-term infected individuals as recently infected makes it difficult to use these assays individually to estimate population level incidence without precise knowledge of the distribution of these subtypes within populations where subtype A and D cocirculate. The association of misclassification of the BED-CEIA with the avidity assay in subtype D-infected individuals limits the utility of using these assays in combination within this population.
authors: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Caroline E
authors: CE
authors: Mullis
authors: Supriya
authors: S
authors: Munshaw
authors: Mary K
authors: MK
authors: Grabowski
authors: Susan H
authors: SH
authors: Eshleman
authors: David
authors: D
authors: Serwadda
authors: Ronald
authors: R
authors: Brookmeyer
authors: Fred
authors: F
authors: Nalugoda
authors: Godfrey
authors: G
authors: Kigozi
authors: Joseph
authors: J
authors: Kagaayi
authors: Aaron A R
authors: AA
authors: Tobian
authors: Maria
authors: M
authors: Wawer
authors: Ronald H
authors: RH
authors: Gray
authors: Thomas C
authors: TC
authors: Quinn
authors: Oliver
authors: O
authors: Laeyendecker
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006679:HIV Seropositivity / Q000453:epidemiology; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D007124:Immunoenzyme Techniques; D015994:Incidence; D008297:Male; D012680:Sensitivity and Specificity; D014454:Uganda / Q000453:epidemiology
references: AIDS Res Hum Retroviruses. 2010 Oct;26(10):1087-91
references: 20925575
references: Lancet Infect Dis. 2009 Dec;9(12):747-59
references: 19926035
references: AIDS Res Hum Retroviruses. 2011 Mar;27(3):265-73
references: 20954834
references: J Infect Dis. 2007 Apr 15;195(8):1177-80
references: 17357054
references: JAMA. 1998 Jul 1;280(1):42-8
references: 9660362
references: PLoS One. 2009 May 28;4(5):e5720
references: 19479050
references: Epidemiol Rev. 2010;32:26-37
references: 20203104
references: PLoS One. 2011 Mar 07;6(3):e17535
references: 21408182
references: Am J Epidemiol. 1995 Jan 15;141(2):166-72
references: 7817972
references: PLoS One. 2008;3(11):e3640
references: 18982059
references: J Infect Dis. 2008 Mar 1;197(5):707-13
references: 18266607
references: J Clin Microbiol. 2004 Jun;42(6):2623-8
references: 15184443
references: Euro Surveill. 2008 Sep 04;13(36):
references: 18775293
references: Mol Biol Evol. 2011 Oct;28(10):2731-9
references: 21546353
references: J Acquir Immune Defic Syndr. 2010 Jun;54(2):180-4
references: 20010433
references: AIDS Res Hum Retroviruses. 2008 Mar;24(3):495-8
references: 18327979
references: Epidemiology. 2010 Sep;21(5):685-97
references: 20699682
references: J Acquir Immune Defic Syndr. 2010 Apr 1;53(4):496-9
references: 20306555
references: AIDS Res Hum Retroviruses. 2012 Jan;28(1):95-9
references: 21314476
references: AIDS Res Hum Retroviruses. 2002 Mar 1;18(4):295-307
references: 11860677
references: AIDS Res Hum Retroviruses. 2012 Oct;28(10):1177-83
references: 22283149
references: AIDS. 2007 Feb 19;21(4):403-8
references: 17301558