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The challenge of discriminating between HIV-1, HIV-2 and HIV-1/2 dual infections

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  • Bo Langhoff Hønge
  • Sanne Jespersen
  • Candida Medina, National HIV Programme, Ministry of Health, Bissau, Guinea-Bissau.
  • ,
  • David da Silva Té, National HIV Programme, Ministry of Health, Bissau, Guinea-Bissau.
  • ,
  • Zacarias José da Silva, Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau; National Public Health Laboratory, Bissau, Guinea-Bissau.
  • ,
  • Mette Christiansen
  • Bertram Kjerulff, Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark.
  • ,
  • Alex Lund Laursen
  • Christian Wejse
  • Henrik Krarup, Aalborg University
  • ,
  • Christian Erikstrup
  • Bissau HIV cohort study group
  • ,
  • Lars Jørgen Østergaard (Member of author collaboration)

OBJECTIVES: Discrimination between HIV-1 and HIV-2 is important to ensure appropriate antiretroviral treatment (ART) and epidemiological surveillance. However, serological tests have shown frequent mistyping when applied in the field. We evaluated two confirmatory tests, INNO-LIA HIV I/II Score and ImmunoComb HIV 1/2 BiSpot, for HIV type discriminatory capacity.

METHODS: Samples from 239 ART-naïve HIV-infected patients from the Bissau HIV Cohort in Guinea-Bissau were selected retrospectively based on the initial HIV typing performed in Bissau, ensuring a broad representation of HIV types. INNO-LIA results were interpreted by the newest software algorithm, and three independent observers read the ImmunoComb results. HIV-1/HIV-2 RNA and DNA were measured for confirmation.

RESULTS: INNO-LIA results showed 123 HIV-1 positive samples, 69 HIV-2 positive and 47 HIV-1/2 dually reactive. There was agreement between INNO-LIA and HIV-1/HIV-2 RNA and DNA detection, although not all HIV-1/2 dually reactive samples could be confirmed by the nucleic acid results. Overall, the observers found that the ImmunoComb results differed from the INNO-LIA results, with agreements of 90.4, 91.2 and 92.5%, respectively, for HIV-1, HIV-2 and HIV-1/2. The combined kappa-score for agreement between the three observers was 0.955 (z-score 35.1; P < 0.01). Of the HIV-2 mono-reactive samples (INNO-LIA), the three observers interpreted 24.6-31.9% as HIV-1/2 dually infected by ImmunoComb. None of these samples had detectable HIV-1 RNA or DNA.

CONCLUSIONS: There was accordance between INNO-LIA calls and nucleic acid results, whereas ImmunoComb overestimated the number of HIV-1/2 dually infected patients. Confirmatory typing is needed for patients diagnosed with HIV-1/2 dual infection by ImmunoComb.

Original languageEnglish
JournalHIV Medicine
Pages (from-to)403-410
Number of pages8
Publication statusPublished - Jul 2018

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