title: Field accuracy of fourth-generation rapid diagnostic tests for acute HIV-1: a systematic review.
abstract: BACKGROUND
  Fourth-generation HIV-1 rapid diagnostic tests (RDTs) detect HIV-1 p24 antigen to screen for acute HIV-1. However, diagnostic accuracy during clinical use may be suboptimal.
  
  
  METHODS
  Clinical sensitivity and specificity of fourth-generation RDTs for acute HIV-1 were collated from field evaluation studies in adults identified by a systematic literature search.
  
  
  RESULTS
  Four studies with 17 381 participants from Australia, Swaziland, the United Kingdom and Malawi were identified. All reported 0% sensitivity of the HIV-1 p24 component for acute HIV-1 diagnosis; 26 acute infections were missed. Specificity ranged from 98.3 to 99.9%.
  
  
  CONCLUSIONS
  Fourth-generation RDTs are currently unsuitable for the detection of acute HIV-1.
authors.affiliation: aWellcome Trust Tropical Centre bDepartment of Clinical Sciences, Liverpool School of Tropical Medicine cDepartment of Public Health and Policy, University of Liverpool dDepartment of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK eCentre for Evidence-based Healthcare, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa fDepartment of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Lewis
authors.forename: Peter
authors.initials: P
authors.lastname: Macpherson
authors.forename: Emily R
authors.initials: ER
authors.lastname: Adams
authors.forename: Eleanor
authors.initials: E
authors.lastname: Ochodo
authors.forename: Anita
authors.initials: A
authors.lastname: Sands
authors.forename: Miriam
authors.initials: M
authors.lastname: Taegtmeyer
mesh_terms: D003955:Diagnostic Tests, Routine / Q000379:methods*; D016655:HIV Core Protein p24 / Q000032:analysis*; D015658:HIV Infections / Q000175:diagnosis* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D016655:HIV Core Protein p24