Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA.
ICAP at Columbia University, New York, NY.
J Acquir Immune Defic Syndr. 2021 Aug 1;87(Suppl 1):S73-S80. doi: 10.1097/QAI.0000000000002707.
HIV-1 incidence calculation currently includes recency classification by HIV-1 incidence assay and unsuppressed viral load (VL ≥ 1000 copies/mL) in a recent infection testing algorithm (RITA). However, persons with recent classification not virally suppressed and taking antiretroviral (ARV) medication may be misclassified.
We used data from 13 African household surveys to describe the impact of an ARV-adjusted RITA on HIV-1 incidence estimates.
HIV-seropositive samples were tested for recency using the HIV-1 Limiting Antigen (LAg)-Avidity enzyme immunoassay, HIV-1 viral load, ARVs used in each country, and ARV drug resistance. LAg-recent result was defined as normalized optical density values ≤1.5. We compared HIV-1 incidence estimates using 2 RITA: RITA1: LAg-recent + VL ≥ 1000 copies/mL and RITA2: RITA1 + undetectable ARV. We explored RITA2 with self-reported ARV use and with clinical history.
Overall, 357 adult HIV-positive participants were classified as having recent infection with RITA1. RITA2 reclassified 55 (15.4%) persons with detectable ARV as having long-term infection. Those with detectable ARV were significantly more likely to be aware of their HIV-positive status (84% vs. 10%) and had higher levels of drug resistance (74% vs. 26%) than those without detectable ARV. RITA2 incidence was lower than RITA1 incidence (range, 0%-30% decrease), resulting in decreased estimated new infections from 390,000 to 341,000 across the 13 countries. Incidence estimates were similar using detectable or self-reported ARV (R2 > 0.995).
Including ARV in RITA2 improved the accuracy of HIV-1 incidence estimates by removing participants with likely long-term HIV infection.
目前，HIV-1 发病率的计算包括 HIV-1 发病率检测和最近感染检测算法（RITA）中未抑制的病毒载量（VL≥1000 拷贝/ml）的近期分类。然而，最近分类但未抑制病毒且服用抗逆转录病毒（ARV）药物的人可能会被错误分类。
我们使用来自 13 项非洲家庭调查的数据来描述经 ARV 调整的 RITA 对 HIV-1 发病率估计的影响。
使用 HIV-1 限性抗原（LAg）亲和酶免疫测定法、HIV-1 病毒载量、每个国家使用的 ARV 和 ARV 耐药性对 HIV-血清阳性样本进行近期分类。LAg 近期结果定义为归一化光密度值≤1.5。我们比较了使用两种 RITA 的 HIV-1 发病率估计：RITA1：LAg 近期+VL≥1000 拷贝/ml 和 RITA2：RITA1+可检测的 ARV。我们使用自我报告的 ARV 使用情况和临床病史探索了 RITA2。
总体而言，357 名 HIV 阳性成年参与者被归类为 RITA1 近期感染。RITA2 将 55 名可检测 ARV 的人重新归类为长期感染。与未检测到 ARV 的人相比，检测到 ARV 的人更有可能意识到自己的 HIV 阳性状态（84% vs. 10%），并且耐药水平更高（74% vs. 26%）。RITA2 的发病率低于 RITA1 的发病率（范围为 0%-30%的下降），导致 13 个国家的新感染估计数从 39 万降至 34.1 万。使用可检测或自我报告的 ARV 时，发病率估计相似（R2>0.995）。
通过将可能长期感染 HIV 的参与者排除在外，将 ARV 纳入 RITA2 可提高 HIV-1 发病率估计的准确性。
