Novel Criteria for Diagnosing Acute and Early Human Immunodeficiency Virus Infection in a Multinational Study of Early Antiretroviral Therapy Initiation

Antiretroviral therapy (ART) initiation during acute and early human immunodeficiency virus infection (AEHI) limits HIV reservoir formation and may facilitate post-ART control but is logistically challenging. We evaluated the performance of AEHI diagnostic criteria from a prospective study of early...

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Veröffentlicht in:Clinical infectious diseases 2021-08, Vol.73 (3), p.e643-e651
Hauptverfasser: Crowell, Trevor A, Ritz, Justin, Coombs, Robert W, Zheng, Lu, Eron, Joseph J, Mellors, John W, Dragavon, Joan, van Zyl, Gert U, Lama, Javier R, Ruxrungtham, Kiat, Grinsztejn, Beatriz, Arduino, Roberto C, Fox, Lawrence, Ananworanich, Jintanat, Daar, Eric S
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container_end_page e651
container_issue 3
container_start_page e643
container_title Clinical infectious diseases
container_volume 73
creator Crowell, Trevor A
Ritz, Justin
Coombs, Robert W
Zheng, Lu
Eron, Joseph J
Mellors, John W
Dragavon, Joan
van Zyl, Gert U
Lama, Javier R
Ruxrungtham, Kiat
Grinsztejn, Beatriz
Arduino, Roberto C
Fox, Lawrence
Ananworanich, Jintanat
Daar, Eric S
description Antiretroviral therapy (ART) initiation during acute and early human immunodeficiency virus infection (AEHI) limits HIV reservoir formation and may facilitate post-ART control but is logistically challenging. We evaluated the performance of AEHI diagnostic criteria from a prospective study of early ART initiation. AIDS Clinical Trials Group A 5354 enrolled adults at 30 sites in the Americas, Africa, and Asia who met any 1 of 6 criteria based on combinations of results of HIV RNA, HIV antibody, Western blot or Geenius assay, and/or the signal-to-cutoff (S/CO) ratio of the ARCHITECT HIV Ag/Ab Combo or GS HIV Combo Ag/Ab EIA. HIV status and Fiebig stage were confirmed by centralized testing. From 2017 through 2019, 195 participants were enrolled with median age of 27 years (interquartile range, 23-39). Thirty (15.4%) were female. ART was started by 171 (87.7%) on the day of enrollment and 24 (12.3%) the next day. AEHI was confirmed in 188 (96.4%) participants after centralized testing, 4 (2.0%) participants were found to have chronic infection, and 3 (1.5%) found not to have HIV discontinued ART and were withdrawn. Retrospectively, a nonreactive or indeterminate HIV antibody on the Geenius assay combined with ARCHITECT S/CO ≥10 correctly identified 99 of 122 (81.2%) Fiebig II-IV AEHI cases with no false-positive results. Novel AEHI criteria that incorporate ARCHITECT S/CO facilitated rapid and efficient ART initiation without waiting for an HIV RNA result. These criteria may facilitate AEHI diagnosis, staging, and immediate ART initiation in future research studies and clinical practice. NCT02859558.
doi_str_mv 10.1093/cid/ciaa1893
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We evaluated the performance of AEHI diagnostic criteria from a prospective study of early ART initiation. AIDS Clinical Trials Group A 5354 enrolled adults at 30 sites in the Americas, Africa, and Asia who met any 1 of 6 criteria based on combinations of results of HIV RNA, HIV antibody, Western blot or Geenius assay, and/or the signal-to-cutoff (S/CO) ratio of the ARCHITECT HIV Ag/Ab Combo or GS HIV Combo Ag/Ab EIA. HIV status and Fiebig stage were confirmed by centralized testing. From 2017 through 2019, 195 participants were enrolled with median age of 27 years (interquartile range, 23-39). Thirty (15.4%) were female. ART was started by 171 (87.7%) on the day of enrollment and 24 (12.3%) the next day. AEHI was confirmed in 188 (96.4%) participants after centralized testing, 4 (2.0%) participants were found to have chronic infection, and 3 (1.5%) found not to have HIV discontinued ART and were withdrawn. 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subjects Adult
Africa
Asia
Female
HIV Infections - diagnosis
HIV Infections - drug therapy
HIV-1
Humans
Online Only
Prospective Studies
Retrospective Studies
title Novel Criteria for Diagnosing Acute and Early Human Immunodeficiency Virus Infection in a Multinational Study of Early Antiretroviral Therapy Initiation
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