Tchounga Boris K, Inwoley Andre, Coffie Patrick A, Minta Daouda, Messou Eugene, Bado Guillaume, Minga Albert, Hawerlander Denise, Kane Coumba, Eholie Serge P, Dabis François, Ekouevi Didier K
Centre INSERM U897-Epidémiologie-Biostatistique, ISPED, Université de Bordeaux, Bordeaux, France; Inserm U897, ISPED, Université de Bordeaux, Bordeaux, France; Programme PACCI, Site de recherche ANRS, Abidjan, Côte d'Ivoire;
Centre de Diagnostic et de Recherche sur le SIDA et les Affections Opportunistes, CHU de Treichville, Abidjan, Côte d'Ivoire.
J Int AIDS Soc. 2014 Aug 11;17(1):19064. doi: 10.7448/IAS.17.1.19064. eCollection 2014.
West Africa is characterized by the circulation of HIV-1 and HIV-2. The laboratory diagnosis of these two infections as well as the choice of a first-line antiretroviral therapy (ART) is challenging, considering the limited access to second-line regimens. This study aimed at confirming the classification of HIV-2 and HIV-1&2 dually reactive patients followed up in the HIV-2 cohort of the West African Database to evaluate AIDS collaboration.
A cross-sectional survey was conducted from March to December 2012 in Burkina Faso, Côte d'Ivoire and Mali among patients classified as HIV-2 or HIV-1&2 dually reactive according to the national HIV testing algorithms. A 5-ml blood sample was collected from each patient and tested in a single reference laboratory in Côte d'Ivoire (CeDReS, Abidjan) with two immuno-enzymatic tests: ImmunoCombII® (HIV-1&2 ImmunoComb BiSpot - Alere) and an in-house ELISA test, approved by the French National AIDS and hepatitis Research Agency (ANRS).
A total of 547 patients were included; 57% of them were initially classified as HIV-2 and 43% as HIV-1&2 dually reactive. Half of the patients had CD4≥500 cells/mm(3) and 68.6% were on ART. Of the 312 patients initially classified as HIV-2, 267 (85.7%) were confirmed as HIV-2 with ImmunoCombII® and in-house ELISA while 16 (5.1%) and 9 (2.9%) were reclassified as HIV-1 and HIV-1&2, respectively (Kappa=0.69; p<0.001). Among the 235 patients initially classified as HIV-1&2 dually reactive, only 54 (23.0%) were confirmed as dually reactive with ImmunoCombII® and in-house ELISA, while 103 (43.8%) and 33 (14.0%) were reclassified as HIV-1 and HIV-2 mono-infected, respectively (kappa= 0.70; p<0.001). Overall, 300 samples (54.8%) were concordantly classified as HIV-2, 63 (11.5%) as HIV-1&2 dually reactive and 119 (21.8%) as HIV-1 (kappa=0.79; p<0.001). The two tests gave discordant results for 65 samples (11.9%).
Patients with HIV-2 mono-infection are correctly discriminated by the national algorithms used in West African countries. HIV-1&2 dually reactive patients should be systematically investigated, with a standardized algorithm using more accurate tests, before initiating ART as at least 4 out of 10 of them could initiate an effective first-line ART for HIV-1 and optimize their second-line treatment options.
西非地区的特点是HIV-1和HIV-2病毒同时传播。鉴于二线治疗方案的获取有限，对这两种感染进行实验室诊断以及选择一线抗逆转录病毒疗法（ART）具有挑战性。本研究旨在确认在西非数据库HIV-2队列中接受随访的HIV-2以及HIV-1&2双重反应性患者的分类情况，以评估艾滋病协作情况。
2012年3月至12月在布基纳法索、科特迪瓦和马里对根据国家HIV检测算法分类为HIV-2或HIV-1&2双重反应性的患者进行了横断面调查。从每位患者采集5毫升血液样本，并在科特迪瓦的一个参考实验室（阿比让的CeDReS）使用两种免疫酶检测方法进行检测：ImmunoCombII®（HIV-1&2免疫组合双斑点法 - 雅培）和一种经法国国家艾滋病和肝炎研究机构（ANRS）批准的内部ELISA检测方法。
共纳入547名患者；其中57%最初被分类为HIV-2，43%为HIV-1&2双重反应性。一半的患者CD4≥500个细胞/mm³，68.6%正在接受ART治疗。在最初分类为HIV-2的312名患者中，267名（85.7%）通过ImmunoCombII®和内部ELISA检测被确认为HIV-2，而16名（5.1%）和9名（2.9%）分别被重新分类为HIV-1和HIV-1&2（kappa = 0.69；p<0.001）。在最初分类为HIV-1&2双重反应性的235名患者中，只有54名（23.0%）通过ImmunoCombII®和内部ELISA检测被确认为双重反应性，而103名（43.8%）和33名（14.0%）分别被重新分类为HIV-1单感染和HIV-2单感染（kappa = 0.70；p<0.001）。总体而言，300个样本（54.8%）被一致分类为HIV-2，63个（11.5%）为HIV-1&2双重反应性，119个（21.8%）为HIV-1（kappa = 0.79；p<0.001）。两种检测方法对65个样本（11.9%）给出了不一致的结果。
西非国家使用的国家算法能够正确区分HIV-2单感染患者。对于HIV-1&2双重反应性患者，在开始ART治疗前应使用更准确的检测方法进行标准化算法的系统调查，因为其中至少十分之四的患者可以开始针对HIV-1的有效一线ART治疗并优化其二线治疗方案。
