BMC Infectious Diseases (Nov 2022)

Evaluation of multi-assay algorithms for cross-sectional HIV incidence estimation in settings with universal antiretroviral treatment

  • Wendy Grant-McAuley,
  • Oliver Laeyendecker,
  • Daniel Monaco,
  • Athena Chen,
  • Sarah E. Hudelson,
  • Ethan Klock,
  • Ron Brookmeyer,
  • Douglas Morrison,
  • Estelle Piwowar-Manning,
  • Charles S. Morrison,
  • Richard Hayes,
  • Helen Ayles,
  • Peter Bock,
  • Barry Kosloff,
  • Kwame Shanaube,
  • Nomtha Mandla,
  • Anneen van Deventer,
  • Ingo Ruczinski,
  • Kai Kammers,
  • H. Benjamin Larman,
  • Susan H. Eshleman

DOI
https://doi.org/10.1186/s12879-022-07850-0
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 11

Abstract

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Abstract Background Multi-assay algorithms (MAAs) are used to estimate population-level HIV incidence and identify individuals with recent infection. Many MAAs use low viral load (VL) as a biomarker for long-term infection. This could impact incidence estimates in settings with high rates of early HIV treatment initiation. We evaluated the performance of two MAAs that do not include VL. Methods Samples were collected from 219 seroconverters (infected 1 year) in the HPTN 071 (PopART) trial; 28.8% of seroconverter samples and 73.2% of non-seroconverter samples had VLs ≤ 400 copies/mL. Samples were tested with the Limiting Antigen Avidity assay (LAg) and JHU BioRad-Avidity assays. Antibody reactivity to two HIV peptides was measured using the MSD U-PLEX assay. Two MAAs were evaluated that do not include VL: a MAA that includes the LAg-Avidity assay and BioRad-Avidity assay (LAg + BR) and a MAA that includes the LAg-Avidity assay and two peptide biomarkers (LAg + PepPair). Performance of these MAAs was compared to a widely used MAA that includes LAg and VL (LAg + VL). Results The incidence estimate for LAg + VL (1.29%, 95% CI: 0.97–1.62) was close to the observed longitudinal incidence (1.34% 95% CI: 1.17–1.53). The incidence estimates for the other two MAAs were higher (LAg + BR: 2.56%, 95% CI 2.01–3.11; LAg + PepPair: 2.84%, 95% CI: 1.36–4.32). LAg + BR and LAg + PepPair also misclassified more individuals infected > 2 years as recently infected than LAg + VL (1.2% [42/3483 and 1.5% [51/3483], respectively, vs. 0.2% [6/3483]). LAg + BR classified more seroconverters as recently infected than LAg + VL or LAg + PepPair (80 vs. 58 and 50, respectively) and identified ~ 25% of virally suppressed seroconverters as recently infected. Conclusions The LAg + VL MAA produced a cross-sectional incidence estimate that was closer to the longitudinal estimate than two MAAs that did not include VL. The LAg + BR MAA classified the greatest number of individual seroconverters as recently infected but had a higher false recent rate.

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