A novel acute HIV infection staging system based on 4th generation immunoassay

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• 作者：Jintanat Ananworanich (1) (2) (3) (4)
  James LK Fletcher (1) (2)
  Suteeraporn Pinyakorn (1) (2) (3)
  Frits van Griensven (2) (3)
  Claire Vandergeeten (5)
  Alexandra Schuetz (6)
  Tippawan Pankam (2)
  Rapee Trichavaroj (6)
  Siriwat Akapirat (6)
  Nitiya Chomchey (1) (2)
  Praphan Phanuphak (1) (2) (3) (4)
  Nicolas Chomont (5)
  Nelson L Michael (7)
  Jerome H Kim (1) (7)
  Mark de Souza (1) (2)
  
• 关键词：Acute HIV infection ; Primary HIV infection ; Fiebig stage ; 4thG stage ; Enzyme immunoassay ; 4th generation EIA ; 2nd generation EIA ; Nucleic acid testing ; Reservoir ; Functional cure
• 刊名：Retrovirology
• 出版年：2013
• 出版时间：December 2013
• 年：2013
• 卷：10
• 期：1
• 全文大小：347KB
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• 作者单位：Jintanat Ananworanich (1) (2) (3) (4)
  James LK Fletcher (1) (2)
  Suteeraporn Pinyakorn (1) (2) (3)
  Frits van Griensven (2) (3)
  Claire Vandergeeten (5)
  Alexandra Schuetz (6)
  Tippawan Pankam (2)
  Rapee Trichavaroj (6)
  Siriwat Akapirat (6)
  Nitiya Chomchey (1) (2)
  Praphan Phanuphak (1) (2) (3) (4)
  Nicolas Chomont (5)
  Nelson L Michael (7)
  Jerome H Kim (1) (7)
  Mark de Souza (1) (2)
  
  1. SEARCH, 104 Tower 2, 2nd Floor, Rajdamri Road, Pathumwan, Bangkok, 10330, Thailand
  2. The Thai Red Cross AIDS Research Centre, 104 Rajdamri Road, Pathumwan, Bangkok, 10330, Thailand
  3. HIV-NAT, 104 Rajdamri Road, Pathumwan, Bangkok, 10330, Thailand
  4. Department of Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV, Pathumwan, Bangkok, 10330, Thailand
  5. Vaccine and Gene Therapy Institute Florida, 9801 SW Discovery way, Port St. Lucie, FL, 34987, USA
  6. Department of Retrovirology, Armed Forces Research Institute of Medical Sciences 鈥?US Component, 315/6 Rajvithi Rd., Bangkok, 10400, Thailand
  7. US Military HIV Research Program, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
  
• ISSN：1742-4690

文摘

Background Fourth generation (4thG) immunoassay (IA) is becoming the standard HIV screening method but was not available when the Fiebig acute HIV infection (AHI) staging system was proposed. Here we evaluated AHI staging based on a 4thG IA (4thG staging). Findings Screening for AHI was performed in real-time by pooled nucleic acid testing (NAT, n=48,828 samples) and sequential enzyme immunoassay (EIA, n=3,939 samples) identifying 63 subjects with non-reactive 2nd generation EIA (Fiebig stages I (n=25), II (n=7), III (n=29), IV (n=2)). The majority of samples tested (n=53) were subtype CRF_01AE (77%). NAT+ subjects were re-staged into three 4thG stages: stage 1 (n=20; 4th gen EIA-, 3rd gen EIA-), stage 2 (n=12; 4th gen EIA+, 3rd gen EIA-), stage 3 (n=31; 4th gen EIA+, 3rd gen EIA+, Western blot-/indeterminate). 4thG staging distinguishes groups of AHI subjects by time since presumed HIV exposure, pattern of CD8+ T, B and natural killer cell absolute numbers, and HIV RNA and DNA levels. This staging system further stratified Fiebig I subjects: 18 subjects in 4thG stage 1 had lower HIV RNA and DNA levels than 7 subjects in 4thG stage 2. Conclusions Using 4th generation IA as part of AHI staging distinguishes groups of patients by time since exposure to HIV, lymphocyte numbers and HIV viral burden. It identifies two groups of Fiebig stage I subjects who display different levels of HIV RNA and DNA, which may have implication for HIV cure. 4th generation IA should be incorporated into AHI staging systems.