A systematic review of limiting antigen avidity enzyme immunoassay for detection of recent HIV-1 infection to expand supported applications

Joseph Kin-On Lau; Nicholas Murdock; Jeffrey Murray; Jessica Justman; Neil Parkin; Veronica Miller

doi:10.1016/j.jve.2022.100085

A systematic review of limiting antigen avidity enzyme immunoassay for detection of recent HIV-1 infection to expand supported applications

J Virus Erad. 2022 Sep 7;8(3):100085. doi: 10.1016/j.jve.2022.100085. eCollection 2022 Sep.

Authors

Joseph Kin-On Lau¹, Nicholas Murdock¹, Jeffrey Murray¹, Jessica Justman², Neil Parkin³, Veronica Miller¹

Affiliations

¹ Forum for Collaborative Research, 1608 Rhode Island Avenue NW, Suite 212, Washington, DC, 20036, USA.
² ICAP Columbia University Mailman School of Public Health, 722 West 168 Street, New York, NY, 10032, USA.
³ Data First Consulting, Inc, Sebastopol, CA, USA.

Abstract

Introduction: The need for detection of new and recent HIV infections is essential for surveillance and assessing interventions in controlling the epidemic. HIV recency assays are one way of providing reliable incidence estimates by determining recent versus non-recent infection. The objective of this study was to review the current body of knowledge of the limiting antigen avidity enzyme immunoassay to expand supported applications through an assessment of what is known and the gaps.

Methods: A search for peer-reviewed literature in PubMed, Embase, and Web of Science Core Collection was conducted using the search term "human immunodeficiency virus and avidity". Non-peer reviewed published reports from the Population-based HIV Impact Assessment Project were also included. These were limited to literature published in English between January 2010 and August 2021.

Results: This search resulted in 2080 publications and 14 reports, with 137 peer-reviewed studies and 14 non-peer reviewed reports that met the inclusion criteria, yielding a total of 151 studies for the final review. There were similar findings among studies that compared the performances of assay manufacturers and sample types. Studies that evaluated various assay algorithms and thresholds were heterogeneous, illustrating the need for context-specific test characteristics for classifying recent infections. Most studies estimated subtype-specific test characteristics for HIV subtypes A, B, C, and D. This was further illustrated when looking only at studies that compared HIV incidence estimates from recency assay algorithms and longitudinal cohorts.

Conclusions: These findings suggest that the current body of knowledge provides important information that contributes towards distinguishing recent and non-recent infection and incidence estimation. However, there are knowledge gaps with respect to factors that influence the test characteristics (e.g., HIV-1 subtype, population characteristics, assay algorithms and thresholds). Further studies are needed to estimate and establish context-specific test characteristics that consider these influencing factors to improve and expand the use of this assay for detection of recent HIV infection.

Keywords: Enzyme-linked immunosorbent assay; HIV-1; Recency assay; Recent infection testing algorithm.

Publication types

Review