Mullis Caroline E, Munshaw Supriya, Grabowski Mary K, Eshleman Susan H, Serwadda David, Brookmeyer Ronald, Nalugoda Fred, Kigozi Godfrey, Kagaayi Joseph, Tobian Aaron A R, Wawer Maria, Gray Ronald H, Quinn Thomas C, Laeyendecker Oliver
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
AIDS Res Hum Retroviruses. 2013 Aug;29(8):1146-50. doi: 10.1089/aid.2012.0105. Epub 2013 May 29.
Assays to determine HIV incidence from cross-sectional surveys have exhibited a high rate of false-recent misclassification in Kenya and Uganda where HIV subtypes A and D predominate. Samples from individuals infected with HIV for at least 2 years with known infecting subtype (133 subtype A, 373 subtype D) were tested using the BED-CEIA and an avidity assay. Both assays had a higher rate of false-recent misclassification for subtype D compared to subtype A (13.7% vs. 6.0%, p=0.02 for BED-CEIA; 11.0% vs. 1.5%, p<0.001 for avidity). For subtype D samples, false-recent misclassification by the BED-CEIA was also more frequent in women than men (15.0% vs. 5.6%, p=0.002), and for samples where that had an amino acid other than lysine at position 12 in the BED-CEIA peptide coding region (p=0.002). Furthermore in subtype D-infected individuals, samples misclassified by one assay were 3.5 times more likely to be misclassified by the other assay. Differential misclassification by infecting subtype of long-term infected individuals as recently infected makes it difficult to use these assays individually to estimate population level incidence without precise knowledge of the distribution of these subtypes within populations where subtype A and D cocirculate. The association of misclassification of the BED-CEIA with the avidity assay in subtype D-infected individuals limits the utility of using these assays in combination within this population.
在以HIV-1 A亚型和D亚型为主的肯尼亚和乌干达，利用横断面调查来确定HIV发病率的检测方法出现了较高比例的近期感染误判。对已知感染亚型且感染HIV至少两年的个体样本（133例A亚型、373例D亚型）进行了BED-CEIA和亲和力检测。与A亚型相比，两种检测方法对D亚型的近期感染误判率均更高（BED-CEIA为13.7%对6.0%，p=0.02；亲和力检测为11.0%对1.5%，p<0.001）。对于D亚型样本，BED-CEIA的近期感染误判在女性中比男性更常见（15.0%对5.6%，p=0.002），并且在BED-CEIA肽编码区第12位氨基酸不是赖氨酸的样本中也更常见（p=0.002）。此外，在感染D亚型的个体中，被一种检测方法误判的样本被另一种检测方法误判的可能性要高3.5倍。将长期感染个体误判为近期感染的情况因感染亚型不同而存在差异，这使得在不精确了解A亚型和D亚型在共同流行人群中分布的情况下，难以单独使用这些检测方法来估计人群水平的发病率。在感染D亚型的个体中，BED-CEIA与亲和力检测的误判相关性限制了在该人群中联合使用这些检测方法的效用。
