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Clin Infect Dis. 2016 Aug 15;63(4):555-61. doi: 10.1093/cid/ciw365. Epub 2016 Jun 17.

Initiation of Antiretroviral Therapy During Acute HIV-1 Infection Leads to a High Rate of Nonreactive HIV Serology.

Author information

1
South East Asia Research Collaboration with Hawaii (SEARCH) Thai Red Cross AIDS Research Centre, Bangkok, Thailand Cooper Human Systems, Cambridge, Massachusetts.
2
Henry M. Jackson Foundation for the Advancement of Military Medicine United States Military HIV Research Program, Bethesda, Maryland.
3
Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, United States Component.
4
Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
5
South East Asia Research Collaboration with Hawaii (SEARCH).
6
South East Asia Research Collaboration with Hawaii (SEARCH) Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
7
HIV Netherlands Australia Thailand Research Collaboration, Bangkok.
8
United States Military HIV Research Program, Bethesda, Maryland Walter Reed Army Institute of Research, Silver Spring, Maryland.
9
International Vaccine Institute, Seoul, South Korea.
10
South East Asia Research Collaboration with Hawaii (SEARCH) Henry M. Jackson Foundation for the Advancement of Military Medicine United States Military HIV Research Program, Bethesda, Maryland.

Abstract

BACKGROUND:

Third- and fourth-generation immunoassays (IAs) are widely used in the diagnosis of human immunodeficiency virus (HIV) infection. Antiretroviral therapy (ART) during acute HIV infection (AHI) may impact HIV-specific antibodies, with failure to develop antibody or seroreversion. We report on the ability of diagnostic tests to detect HIV-specific antibodies in Thai participants initiating ART during AHI.

METHODS:

Participants with detectable plasma HIV RNA but nonreactive HIV-specific immunoglobulin G, enrolled in an AHI study, were offered immediate initiation of ART. Participants were tested at initiation and at 12 and 24 weeks following treatment using standard second-, third-, and fourth-generation IAs and Western blot (WB).

RESULTS:

Participants (N = 234) initiating ART at a median of 19 days (range, 1-62 days) from HIV exposure demonstrated different frequencies of reactivity prior to and following 24 weeks of ART depending on the IA. Third-generation IA nonreactivity prior to ART was 48%, which decreased to 4% following ART (P < .001). Fourth-generation IA nonreactivity was 18% prior to ART and 17% following ART (P = .720). Negative WB results were observed in 89% and 12% of participants prior to and following 24 weeks of ART, respectively (P < .001). Seroreversion to nonreactivity during ART was observed to at least one of the tests in 20% of participants, with fourth-generation IA demonstrating the highest frequency (11%) of seroreversion.

CONCLUSIONS:

HIV-specific antibodies may fail to develop and, when detected, may decline when ART is initiated during AHI. Although fourth-generation IA was the most sensitive at detecting AHI prior to ART, third-generation IA was the most sensitive during treatment.

CLINICAL TRIALS REGISTRATION:

NCT00796146 and NCT00796263.

KEYWORDS:

Bangkok; HIV-1; acute HIV infection; immunoassay; seroreversion

PMID:
27317797
DOI:
10.1093/cid/ciw365
[Indexed for MEDLINE]

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