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Home >> Publications >> Re-testing and misclassification of HIV-2 and HIV-1&2 dually reactive patients among the HIV-2 cohort of the West African Database to evaluate AIDS collaboration.

Publication

Author(s):

Tchounga BK, Inwoley A, Coffie PA, Minta D, Messou E, Bado G, Minga A, Hawerlander D, Kane C, Eholie SP, Dabis F, Ekouevi DK; WADA Collaboration.

Pub Title:

Re-testing and misclassification of HIV-2 and HIV-1&2 dually reactive patients among the HIV-2 cohort of the West African Database to evaluate AIDS collaboration.

Pub Date:

Aug 11 2014

Pub Region(s):

West Africa

Journal:

Title: 
JIAS- Journal of the International AIDS Society
Link: 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4134669/

PubMed: 25128907
Pub PDF: PDF icon 25128907.pdf

Abstract
INTRODUCTION:
West Africa is characterized by the circulation of HIV-1 and HIV-2. The laboratory diagnosis of these two infections as well as the choice of a first-line antiretroviral therapy (ART) is challenging, considering the limited access to second-line regimens. This study aimed at confirming the classification of HIV-2 and HIV-1&2 dually reactive patients followed up in the HIV-2 cohort of the West African Database to evaluate AIDS collaboration.

METHOD: A cross-sectional survey was conducted from March to December 2012 in Burkina Faso, Côte d'Ivoire and Mali among patients classified as HIV-2 or HIV-1&2 dually reactive according to the national HIV testing algorithms. A 5-ml blood sample was collected from each patient and tested in a single reference laboratory in Côte d'Ivoire (CeDReS, Abidjan) with two immuno-enzymatic tests: ImmunoCombII® (HIV-1&2 ImmunoComb BiSpot - Alere) and an in-house ELISA test, approved by the French National AIDS and hepatitis Research Agency (ANRS).

RESULTS: A total of 547 patients were included; 57% of them were initially classified as HIV-2 and 43% as HIV-1&2 dually reactive. Half of the patients had CD4≥500 cells/mm(3) and 68.6% were on ART. Of the 312 patients initially classified as HIV-2, 267 (85.7%) were confirmed as HIV-2 with ImmunoCombII® and in-house ELISA while 16 (5.1%) and 9 (2.9%) were reclassified as HIV-1 and HIV-1&2, respectively (Kappa=0.69; p<0.001). Among the 235 patients initially classified as HIV-1&2 dually reactive, only 54 (23.0%) were confirmed as dually reactive with ImmunoCombII® and in-house ELISA, while 103 (43.8%) and 33 (14.0%) were reclassified as HIV-1 and HIV-2 mono-infected, respectively (kappa= 0.70; p<0.001). Overall, 300 samples (54.8%) were concordantly classified as HIV-2, 63 (11.5%) as HIV-1&2 dually reactive and 119 (21.8%) as HIV-1 (kappa=0.79; p<0.001). The two tests gave discordant results for 65 samples (11.9%).

CONCLUSIONS: Patients with HIV-2 mono-infection are correctly discriminated by the national algorithms used in West African countries. HIV-1&2 dually reactive patients should be systematically investigated, with a standardized algorithm using more accurate tests, before initiating ART as at least 4 out of 10 of them could initiate an effective first-line ART for HIV-1 and optimize their second-line treatment options.

KEYWORDS: HIV-1&2 dually reactive; HIV-2; West Africa; classification; testing

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Citation:

Tchounga BK, Inwoley A, Coffie PA, Minta D, Messou E, Bado G, Minga A, Hawerlander D, Kane C, Eholie SP, Dabis F, Ekouevi DK; WADA Collaboration. Re-testing and misclassification of HIV-2 and HIV-1&amp;2 dually reactive patients among the HIV-2 cohort of the West African Database to evaluate AIDS collaboration. J Int AIDS Soc. 2014 Aug 11;17(1):19064. doi: 10.7448/IAS.17.1.19064. eCollection 2014. PubMed PMID: 25128907.