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Discordant rapid HIV tests: lessons from a low-resource community.

A A Adetunji1, M A Kuti2, R A Audu3

  • 1Department of Family Medicine, University College Hospital, Ibadan, Nigeria.

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|August 1, 2017
PubMed
Summary

Discordant rapid HIV tests in individuals with recent sexual risk behavior should raise suspicion for early HIV infection, especially in low-prevalence settings. This finding is crucial for frontline health workers managing potential acute HIV cases.

Keywords:
AfricaHIVHIV antibody testacute HIV infectiondiscordant rapid testsearly HIV infectionrapid HIV test

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Area of Science:

  • Infectious Diseases
  • Public Health
  • Diagnostic Testing

Background:

  • HIV rapid antibody tests are essential for HIV screening in Africa.
  • Discordant results between dual rapid tests can occur, raising questions about their implication for early HIV infection detection.
  • Previous studies focused on high HIV prevalence populations, leaving a gap in understanding discordant test results in low prevalence settings.

Purpose of the Study:

  • To investigate the occurrence and significance of discordant rapid HIV tests in a low-resource community.
  • To determine if discordant rapid tests are indicative of early HIV infection in populations with low HIV prevalence.
  • To assess the association between discordant rapid tests and indicators of acute HIV infection.

Main Methods:

  • A cross-sectional study enrolled HIV status-unaware adults with recent exposure to unsafe sex, assessed using the UNC-Malawi Risk Screening Score.
  • Participants underwent dual rapid HIV testing (Determine™ HIV 1/2 and Uni-Gold™ HIV) and plasma HIV-1 antigen testing (COBAS® Ampliprep/COBAS® Taqman® HIV-1 assay).
  • Western blot was performed for individuals with detected HIV-1 antigen to confirm HIV status.

Main Results:

  • Of 408 participants, 1.0% had established HIV infection.
  • The prevalence of discordant rapid tests was 2.45% (sequential) and 2.94% (simultaneous).
  • Discordant rapid tests were significantly associated with higher risk scores (OR 10.88) and detectable HIV-1 RNA (OR 26.06), indicating early HIV infection.

Conclusions:

  • In low HIV prevalence populations, discordant rapid HIV tests in individuals with sexual risk behavior should strongly suggest early HIV infection when discordance rates are below 5%.
  • These findings support heightened clinical suspicion for acute HIV when rapid tests yield conflicting results in at-risk individuals.
  • The study highlights the importance of considering discordant rapid tests as a potential indicator of early HIV infection in diverse epidemiological settings.