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Seroconversion, seroreversion, and serowaffling among participants initiating antiretroviral therapy in Project

Joanne D Stekler1,2,3, Lauren R Violette1,3, Lisa A Niemann1

  • 1Department of Medicine, University of Washington, Seattle, WA, USA.

International Journal of STD & AIDS
|January 27, 2023
PubMed

Insights

Incomplete HIV seroconversion and seroreversion are increasingly recognized issues in testing programs. Oral fluid tests may be more prone to false negatives, impacting HIV diagnosis and treatment.

Area of Science:

  • Infectious Diseases
  • Public Health
  • Diagnostic Testing

Background:

  • Incomplete HIV seroconversion and seroreversion are increasingly documented in HIV testing and pre-exposure prophylaxis (PrEP) programs.
  • These phenomena pose challenges for accurate HIV diagnosis and monitoring, particularly in individuals on antiretroviral treatment.
  • Understanding the nuances of these testing discrepancies is crucial for effective HIV prevention and care strategies.

Purpose of the Study:

  • To analyze incomplete seroconversion and seroreversion patterns based on specimen and test type.
  • To investigate the frequency of seroreversion and "serowaffling" (fluctuating test results) in a longitudinal study.
  • To explore potential associations between Fiebig stage at antiretroviral therapy (ART) initiation and seroconversion outcomes.

Main Methods:

  • Utilized data from Project DETECT, a longitudinal study involving point-of-care HIV tests.
  • Defined "incomplete seroconversion" as persistent nonreactive tests at study censoring.
  • Defined "seroreversion" as regression to nonreactive after a reactive result, and "serowaffling" as reactive-nonreactive-reactive results.
  • Employed Fisher's exact tests to examine relationships between Fiebig stage and seroconversion outcomes.

Main Results:

  • Ten out of 1940 participants exhibited incomplete seroconversion, with eight showing seroreversion.
  • Incomplete seroconversion with persistent nonreactive results was observed exclusively with oral fluid (OF) tests.
  • Seroreversion of OF tests occurred in six participants; two participants showed seroreversion in fingerstick and venipuncture tests.
  • Serowaffling was observed in 45% of participants (nine individuals).
  • No significant associations were found between Fiebig stage at ART initiation and the observed seroconversion patterns.

Conclusions:

  • Oral fluid HIV tests may be particularly susceptible to false-negative results, contributing to incomplete seroconversion.
  • Seroreversion and incomplete seroconversion in individuals on ART represent a growing concern for HIV testing and treatment programs.
  • Further research is needed to refine HIV testing strategies and address discrepancies in individuals undergoing treatment.
Abstract

Keywords:
HIV (human immunodeficiency virus)art (antiretroviral therapy)otherviral disease

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