HIV testing in a high-incidence population: is antibody testing alone good enough?

Area of Science:

• Infectious Diseases
• Virology
• Public Health

Background:

• The Centers for Disease Control and Prevention (CDC) recommends expanding human immunodeficiency virus (HIV) antibody testing.
• HIV antibody tests have longer detection windows post-acquisition compared to nucleic acid amplification tests (NAATs).

Purpose of the Study:

• To evaluate the sensitivity of the OraQuick rapid HIV antibody test compared to NAAT and enzyme immunoassays.
• To assess the utility of antigen-antibody combination assays for detecting acute HIV infection.

Main Methods:

• The OraQuick Advance Rapid HIV-1/2 Antibody Test was used on oral fluid and finger-stick blood specimens from men who have sex with men (MSM).
• Enzyme immunoassays confirmed reactive rapid tests and screened specimens for NAAT.
• Serum samples from HIV-infected individuals were retrospectively tested with various assays, including a fourth-generation antigen-antibody combination assay.

Main Results:

• From 2003-2008, 2.3% of specimens were HIV antibody positive, and 0.3% of antibody-negative specimens were NAAT positive, indicating acute HIV infection.
• OraQuick detected 91% of antibody-positive MSM and 80% of HIV-infected MSM identified by the NAAT program.
• A fourth-generation antigen-antibody assay detected HIV in 15 of 16 MSM with acute HIV infection.

Conclusions:

• OraQuick may exhibit lower sensitivity than enzyme immunoassays during early HIV infection.
• NAAT integration is recommended for HIV testing programs serving populations with frequent testing and high HIV acquisition rates, especially when rapid antibody testing is used.
• Antigen-antibody combination assays show promise as a sensitive alternative to HIV NAAT for early detection.