title: Short Communication: Low False Recent Rate of Limiting Antigen-Avidity Assay Combined with HIV-1 RNA Data in Botswana.
abstract: Cross-sectional estimation of HIV incidence could misclassify some established or chronic HIV infections as recent. Usually long-term nonprogressors, elite and viremic controllers, and individuals on ART contribute to misclassification. Local data on the false recent rate (FRR) could minimize misclassification during estimation of HIV incidence. To improve monitoring of HIV incidence, we estimated local FRR in Botswana. A total of 1,036 specimens from individuals infected for at least 1.5-2 years were sampled between 2004 and 2009 and tested using the limiting antigen (LAg)-avidity assay using a cutoff of 1.5 normalized optical density units. The FRR was 0.97% (10/1,036; 95% confidence interval [CI] 0.46-1.77). Four samples had HIV-1 RNA >1,000 cps/ml, giving an adjusted FRR of 0.39% (4/1,036; 95% CI 0.11-0.99). A combination of LAg and HIV-1 RNA load data resulted in FRR below 1% in the Botswana population.
authors.affiliation: 1 Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University , Tygerberg, South Africa .|2 Botswana Harvard AIDS Institute , Gaborone, Botswana .
authors.forename: Sikhulile
authors.initials: S
authors.lastname: Moyo
authors.affiliation: 2 Botswana Harvard AIDS Institute , Gaborone, Botswana .
authors.forename: Kenanao P
authors.initials: KP
authors.lastname: Kotokwe
authors.affiliation: 2 Botswana Harvard AIDS Institute , Gaborone, Botswana .
authors.forename: Terence
authors.initials: T
authors.lastname: Mohammed
authors.affiliation: 2 Botswana Harvard AIDS Institute , Gaborone, Botswana .
authors.forename: Corretah
authors.initials: C
authors.lastname: Boleo
authors.affiliation: 2 Botswana Harvard AIDS Institute , Gaborone, Botswana .
authors.forename: Lucy
authors.initials: L
authors.lastname: Mupfumi
authors.affiliation: 1 Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University , Tygerberg, South Africa .|3 National Health Laboratory , Ministry of Health, Gaborone, Botswana .
authors.forename: Samuel
authors.initials: S
authors.lastname: Chishala
authors.affiliation: 1 Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University , Tygerberg, South Africa .
authors.forename: Lesedi
authors.initials: L
authors.lastname: Tsalaile
authors.affiliation: 2 Botswana Harvard AIDS Institute , Gaborone, Botswana .|4 Harvard T.H. Chan School of Public Health , Boston, Massachusetts.
authors.forename: Hermann
authors.initials: H
authors.lastname: Bussmann
authors.affiliation: 2 Botswana Harvard AIDS Institute , Gaborone, Botswana .|4 Harvard T.H. Chan School of Public Health , Boston, Massachusetts.
authors.forename: Simani
authors.initials: S
authors.lastname: Gaseitsiwe
authors.affiliation: 2 Botswana Harvard AIDS Institute , Gaborone, Botswana .|4 Harvard T.H. Chan School of Public Health , Boston, Massachusetts.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Musonda
authors.affiliation: 2 Botswana Harvard AIDS Institute , Gaborone, Botswana .|4 Harvard T.H. Chan School of Public Health , Boston, Massachusetts.
authors.forename: Joseph
authors.initials: J
authors.lastname: Makhema
authors.affiliation: 5 Florida International University , College of Health and Urban Affairs, Miami, Florida.
authors.forename: Marianna
authors.initials: M
authors.lastname: Baum
authors.affiliation: 2 Botswana Harvard AIDS Institute , Gaborone, Botswana .|4 Harvard T.H. Chan School of Public Health , Boston, Massachusetts.
authors.forename: Richard
authors.initials: R
authors.lastname: Marlink
authors.affiliation: 1 Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University , Tygerberg, South Africa .|6 National Health Laboratory Services (NHLS) , Tygerberg Coastal, South Africa .
authors.forename: Susan
authors.initials: S
authors.lastname: Engelbrecht
authors.affiliation: 2 Botswana Harvard AIDS Institute , Gaborone, Botswana .|4 Harvard T.H. Chan School of Public Health , Boston, Massachusetts.
authors.forename: Max
authors.initials: M
authors.lastname: Essex
authors.affiliation: 2 Botswana Harvard AIDS Institute , Gaborone, Botswana .|4 Harvard T.H. Chan School of Public Health , Boston, Massachusetts.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Novitsky
mesh_terms: D000328:Adult; D000915:Antibody Affinity; D001902:Botswana / Q000453:epidemiology; D003951:Diagnostic Errors; D005260:Female; D015488:HIV Antigens / Q000276:immunology*; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology / Q000821:virology; D006801:Humans; D007118:Immunoassay / Q000379:methods*; D015994:Incidence; D008297:Male; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D012367:RNA, Viral / Q000097:blood*
chemical_list: D015488:HIV Antigens; D012367:RNA, Viral
keywords: HIV incidence; HIV recency; cross-sectional incidence; false recency rate; limiting antigen assay