Evaluation of the false recent classification rates of multiassay algorithms in estimating HIV type 1 subtype C incidence.
Laboratory cross-sectional assays are useful for the estimation of HIV incidence, but are known to misclassify individuals with long-standing infection as recently infected. The false recent rate (FRR) varies widely across geographic areas; therefore, accurate estimates of HIV incidence require a locally defined FRR. We determined FRR for Botswana, where HIV-1 subtype C infection is predominant, using the BED capture enzyme immunoassay (BED), a Bio-Rad Avidity Index (BAI) assay (a modification of the Bio-Rad HIV1/2+O EIA), and two multiassay algorithms (MAA) that included clinical data. To estimate FRR, stored blood samples from 512 antiretroviral (ARV)-naive HIV-1 subtype C-infected individuals from a prospective cohort in Botswana were tested at 18-24 months postenrollment. The following FRR mean (95% CI) values were obtained: BED 6.05% (4.15-8.48), BAI 5.57% (3.70-8.0), BED-BAI 2.25% (1.13-4.0), and a combination of BED-BAI with CD4 (>200) and viral load (>400) threshold 1.43% (0.58-2.93). The interassay agreement between BED and BAI was 92.8% (95% CI, 90.1-94.5) for recent/long-term classification. Misclassification was associated with viral suppression for BED [adjusted OR (aOR) 10.31; p=0.008], BAI [aOR 9.72; p=0.019], and MAA1 [aOR 16.6; p=0.006]. Employing MAA can reduce FRR to <2%. A local FRR can improve cross-sectional HIV incidence estimates.
1 Botswana-Harvard AIDS Institute Partnership , Gaborone, Botswana .
Sikhulile
S
Moyo
Tessa
T
LeCuyer
Rui
R
Wang
Simani
S
Gaseitsiwe
Jia
J
Weng
Rosemary
R
Musonda
Hermann
H
Bussmann
Madisa
M
Mine
Susan
S
Engelbrecht
Joseph
J
Makhema
Richard
R
Marlink
Marianna K
MK
Baum
Vladimir
V
Novitsky
M
M
Essex
D000328:Adult; D000465:Algorithms; D001902:Botswana / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D005260:Female; D005843:Geography; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000097:blood* / Q000453:epidemiology*; D006679:HIV Seropositivity / Q000453:epidemiology*; D015497:HIV-1 / Q000145:classification*; D006801:Humans; D007124:Immunoenzyme Techniques; D015994:Incidence; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies; D019562:Viral Load
D015483:HIV Antibodies