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Estimating False-Recent Classification for the Limiting-Antigen Avidity EIA and BED-Capture Enzyme Immunoassay in Vietnam: Implications for HIV-1 Incidence Estimates.

Estimating False-Recent Classification for the Limiting-Antigen Avidity EIA and BED-Capture Enzyme Immunoassay in Vietnam: Implications for HIV-1 Incidence Estimates.
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Shah NS, Duong YT, Le LV, Tuan NA, Parekh B, Ha HT, Pham QD, Cuc CT, Dobbs T, Tram TH, Lien TT, Wagar N, Yang C, Martin A, Wolfe MI, Nguyen HT, Kim AA,


Shah NS, Duong YT, Le LV, Tuan NA, Parekh B, Ha HT, Pham QD, Cuc CT, Dobbs T, Tram TH, Lien TT, Wagar N, Yang C, Martin A, Wolfe MI, Nguyen HT, Kim AA, (click to view)

Shah NS, Duong YT, Le LV, Tuan NA, Parekh B, Ha HT, Pham QD, Cuc CT, Dobbs T, Tram TH, Lien TT, Wagar N, Yang C, Martin A, Wolfe MI, Nguyen HT, Kim AA,

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AIDS research and human retroviruses 2017 02 14() doi 10.1089/AID.2016.0203

Abstract
BACKGROUND
Laboratory tests that can distinguish recent from long-term HIV infection are used to estimate HIV incidence in a population but can potentially misclassify a proportion of long-term HIV infections as recent. Correct application of an assay requires determination of the proportion false recents (PFR) as part of the assay characterization and for calculating HIV incidence in a local population using a HIV incidence assay.

METHODS
From April 2009 to December 2010, blood specimens were collected from HIV-infected individuals attending 9 outpatient clinics (OPCs) in Vietnam (4 from northern and 5 from southern Vietnam). Participants were living with HIV for ≥1 year and reported no antiretroviral drug (ARV) treatment. Basic demographic data and clinical information were collected. Specimens were tested with the BED capture enzyme immunoassay (BED-CEIA) and the Limiting-antigen (LAg)-Avidity EIA. PFR was estimated by dividing the number of specimens classified as recent by the total number of specimens; 95% confidence intervals (CI) were calculated. Specimens that tested recent had viral load testing performed.

RESULTS
Among 1,813 specimens (north, n= 942 and south, n = 871), the LAg-Avidity EIA PFR was 1.7% (CI 1.2-2.4) and differed by region [north 2.7% (CI 1.8, 3.9) versus south 0.7% (CI 0.3, 1.5); p=0.002]. The BED-CEIA PFR was 2.3% (CI 1.7, 3.0) and varied by region [north 3.4% (CI: 2.4, 4.7) versus south 1.0% (CI 0.5, 1.2), p<0.001]. Excluding specimens with an undetectable VL, the LAg-Avidity EIA PFR was 1.2% (CI: 0.8, 1.9) and the BED-CEIA PFR was 1.7% (CI: 1.2, 2.4). CONCLUSIONS
The LAg-Avidity EIA PFR was lower than the BED-CEIA PFR. After excluding specimens with an undetectable VL, the PFR for both assays was similar. A low PFR should facilitate the implementation of the LAg-Avidity EIA for cross-sectional incidence estimates in Vietnam.

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