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Validation of the Limiting Antigen Avidity Assay to Estimate Level and Trends in HIV Incidence in an A/D epidemic in Rakai, Uganda

Objective: The Limiting-Antigen Avidity Assay (LAg-Avidity) with viral load >1000 copies/ml is being used to estimate population-level HIV incidence in Africa. However, this has not been validated in East Africa where HIV-1 subtypes A and D circulate. Methods: Sera from persons seen in two surveys (... Full description

Journal Title: AIDS research and human retroviruses 2018, Vol.35 (ja), p.364-367
Main Author: Laeyendecker, Oliver
Other Authors: Gray, Ronald , Grabowski, Mary , Reynolds, Steven , Ndyanabo, Anthony , Ssekasanvu, Joseph , Fernandez, Reinaldo , Wawer, Maria , Serwadda, David , Quinn, Thomas C
Format: Electronic Article Electronic Article
Language: English
Subjects:
Adjustment
Adolescent
Adult
AIDS/HIV
Antibody Affinity
Antigens
Assaying
Avidity
Cohort Studies
Confidence intervals
Constraining
cross-sectional incidence estimation
Disease control
Epidemics
Epidemiology
HIV
HIV Antibodies - immunology
HIV Antigens - blood
HIV Infections - diagnosis
HIV Infections - epidemiology
Human immunodeficiency virus
Humans
Incidence
Middle Aged
Serologic Tests - methods
Serologic Tests - standards
Trends
Uganda
Uganda - epidemiology
validation
Viral Load - methods
Young Adult
Quelle: Alma/SFX Local Collection
Publisher: United States: Mary Ann Liebert, Inc
ID: ISSN: 0889-2229
Link: https://www.ncbi.nlm.nih.gov/pubmed/30560723
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recordid: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6461304
title: Validation of the Limiting Antigen Avidity Assay to Estimate Level and Trends in HIV Incidence in an A/D epidemic in Rakai, Uganda
format: Article
creator:
  • Laeyendecker, Oliver
  • Gray, Ronald
  • Grabowski, Mary
  • Reynolds, Steven
  • Ndyanabo, Anthony
  • Ssekasanvu, Joseph
  • Fernandez, Reinaldo
  • Wawer, Maria
  • Serwadda, David
  • Quinn, Thomas C
subjects:
  • Adjustment
  • Adolescent
  • Adult
  • AIDS/HIV
  • Antibody Affinity
  • Antigens
  • Assaying
  • Avidity
  • Cohort Studies
  • Confidence intervals
  • Constraining
  • cross-sectional incidence estimation
  • Disease control
  • Epidemics
  • Epidemiology
  • HIV
  • HIV Antibodies - immunology
  • HIV Antigens - blood
  • HIV Infections - diagnosis
  • HIV Infections - epidemiology
  • Human immunodeficiency virus
  • Humans
  • Incidence
  • Middle Aged
  • Serologic Tests - methods
  • Serologic Tests - standards
  • Trends
  • Uganda
  • Uganda - epidemiology
  • validation
  • Viral Load - methods
  • Young Adult
ispartof: AIDS research and human retroviruses, 2018, Vol.35 (ja), p.364-367
description: Objective: The Limiting-Antigen Avidity Assay (LAg-Avidity) with viral load >1000 copies/ml is being used to estimate population-level HIV incidence in Africa. However, this has not been validated in East Africa where HIV-1 subtypes A and D circulate. Methods: Sera from persons seen in two surveys (2008-09 and 2012-13) limited to those who attended the previous round of the Rakai Community Cohort in Uganda were analyzed. The performance of the current LAg-Avidity protocol, with a mean duration of recent infection (MDRI) of 130 days and false recent rate (FRR) of 0% was compared to subtype-specific MDRI and FRR, adjusted to subtype distributions. Results: The observed incidence was 1.05/100 person-years (py) (95%CI 0.90, 1.23) in 2008-09, and 0.66/100 py (95%CI 0.52, 0.83) in 2012-2013. In contrast, the per-protocol LAg-Avidity incidence estimates were 1.63/100 py (95%CI 0.97, 2.30) in 2008-09, and 2.55/100 py (95% CI 1.51, 3.59) in 2012-13 (a significant increase, P
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0889-2229
fulltext: fulltext
issn:
  • 0889-2229
  • 1931-8405
url: Link


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titleValidation of the Limiting Antigen Avidity Assay to Estimate Level and Trends in HIV Incidence in an A/D epidemic in Rakai, Uganda
sourceAlma/SFX Local Collection
creatorLaeyendecker, Oliver ; Gray, Ronald ; Grabowski, Mary ; Reynolds, Steven ; Ndyanabo, Anthony ; Ssekasanvu, Joseph ; Fernandez, Reinaldo ; Wawer, Maria ; Serwadda, David ; Quinn, Thomas C
creatorcontribLaeyendecker, Oliver ; Gray, Ronald ; Grabowski, Mary ; Reynolds, Steven ; Ndyanabo, Anthony ; Ssekasanvu, Joseph ; Fernandez, Reinaldo ; Wawer, Maria ; Serwadda, David ; Quinn, Thomas C
descriptionObjective: The Limiting-Antigen Avidity Assay (LAg-Avidity) with viral load >1000 copies/ml is being used to estimate population-level HIV incidence in Africa. However, this has not been validated in East Africa where HIV-1 subtypes A and D circulate. Methods: Sera from persons seen in two surveys (2008-09 and 2012-13) limited to those who attended the previous round of the Rakai Community Cohort in Uganda were analyzed. The performance of the current LAg-Avidity protocol, with a mean duration of recent infection (MDRI) of 130 days and false recent rate (FRR) of 0% was compared to subtype-specific MDRI and FRR, adjusted to subtype distributions. Results: The observed incidence was 1.05/100 person-years (py) (95%CI 0.90, 1.23) in 2008-09, and 0.66/100 py (95%CI 0.52, 0.83) in 2012-2013. In contrast, the per-protocol LAg-Avidity incidence estimates were 1.63/100 py (95%CI 0.97, 2.30) in 2008-09, and 2.55/100 py (95% CI 1.51, 3.59) in 2012-13 (a significant increase, P<0.05.) However, using a subtype specific MDRI and FRR, the subtype adjusted incidence was 0.88% (95%CI 0.44, 1.33) in 2008-09 and 0.67% (95%CI 0.00, 1.68) in 2012-13, approximating to the observed incidence trends. Conclusions: In this subtype A/D epidemic, the per protocol LAg-Avidity +VL assay overestimated HIV incidence and failed to detect declines in incidence. Adjustment for FRR, MDRI and subtype distribution, provided incidence estimates similar to empirically observed incidence level and trends. Thus, use of the LAg-Avidity assay in an A/D epidemic, requires adjustment for subtype.
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subjectAdjustment ; Adolescent ; Adult ; AIDS/HIV ; Antibody Affinity ; Antigens ; Assaying ; Avidity ; Cohort Studies ; Confidence intervals ; Constraining ; cross-sectional incidence estimation ; Disease control ; Epidemics ; Epidemiology ; HIV ; HIV Antibodies - immunology ; HIV Antigens - blood ; HIV Infections - diagnosis ; HIV Infections - epidemiology ; Human immunodeficiency virus ; Humans ; Incidence ; Middle Aged ; Serologic Tests - methods ; Serologic Tests - standards ; Trends ; Uganda ; Uganda - epidemiology ; validation ; Viral Load - methods ; Young Adult
ispartofAIDS research and human retroviruses, 2018, Vol.35 (ja), p.364-367
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2Grabowski, Mary
3Reynolds, Steven
4Ndyanabo, Anthony
5Ssekasanvu, Joseph
6Fernandez, Reinaldo
7Wawer, Maria
8Serwadda, David
9Quinn, Thomas C
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0Validation of the Limiting Antigen Avidity Assay to Estimate Level and Trends in HIV Incidence in an A/D epidemic in Rakai, Uganda
1AIDS research and human retroviruses
addtitleAIDS Res Hum Retroviruses
descriptionObjective: The Limiting-Antigen Avidity Assay (LAg-Avidity) with viral load >1000 copies/ml is being used to estimate population-level HIV incidence in Africa. However, this has not been validated in East Africa where HIV-1 subtypes A and D circulate. Methods: Sera from persons seen in two surveys (2008-09 and 2012-13) limited to those who attended the previous round of the Rakai Community Cohort in Uganda were analyzed. The performance of the current LAg-Avidity protocol, with a mean duration of recent infection (MDRI) of 130 days and false recent rate (FRR) of 0% was compared to subtype-specific MDRI and FRR, adjusted to subtype distributions. Results: The observed incidence was 1.05/100 person-years (py) (95%CI 0.90, 1.23) in 2008-09, and 0.66/100 py (95%CI 0.52, 0.83) in 2012-2013. In contrast, the per-protocol LAg-Avidity incidence estimates were 1.63/100 py (95%CI 0.97, 2.30) in 2008-09, and 2.55/100 py (95% CI 1.51, 3.59) in 2012-13 (a significant increase, P<0.05.) However, using a subtype specific MDRI and FRR, the subtype adjusted incidence was 0.88% (95%CI 0.44, 1.33) in 2008-09 and 0.67% (95%CI 0.00, 1.68) in 2012-13, approximating to the observed incidence trends. Conclusions: In this subtype A/D epidemic, the per protocol LAg-Avidity +VL assay overestimated HIV incidence and failed to detect declines in incidence. Adjustment for FRR, MDRI and subtype distribution, provided incidence estimates similar to empirically observed incidence level and trends. Thus, use of the LAg-Avidity assay in an A/D epidemic, requires adjustment for subtype.
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1Adolescent
2Adult
3AIDS/HIV
4Antibody Affinity
5Antigens
6Assaying
7Avidity
8Cohort Studies
9Confidence intervals
10Constraining
11cross-sectional incidence estimation
12Disease control
13Epidemics
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15HIV
16HIV Antibodies - immunology
17HIV Antigens - blood
18HIV Infections - diagnosis
19HIV Infections - epidemiology
20Human immunodeficiency virus
21Humans
22Incidence
23Middle Aged
24Serologic Tests - methods
25Serologic Tests - standards
26Trends
27Uganda
28Uganda - epidemiology
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30Viral Load - methods
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titleValidation of the Limiting Antigen Avidity Assay to Estimate Level and Trends in HIV Incidence in an A/D epidemic in Rakai, Uganda
authorLaeyendecker, Oliver ; Gray, Ronald ; Grabowski, Mary ; Reynolds, Steven ; Ndyanabo, Anthony ; Ssekasanvu, Joseph ; Fernandez, Reinaldo ; Wawer, Maria ; Serwadda, David ; Quinn, Thomas C
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16HIV Antibodies - immunology
17HIV Antigens - blood
18HIV Infections - diagnosis
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25Serologic Tests - standards
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jtitleAIDS research and human retroviruses
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risdate2018
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issn0889-2229
eissn1931-8405
abstractObjective: The Limiting-Antigen Avidity Assay (LAg-Avidity) with viral load >1000 copies/ml is being used to estimate population-level HIV incidence in Africa. However, this has not been validated in East Africa where HIV-1 subtypes A and D circulate. Methods: Sera from persons seen in two surveys (2008-09 and 2012-13) limited to those who attended the previous round of the Rakai Community Cohort in Uganda were analyzed. The performance of the current LAg-Avidity protocol, with a mean duration of recent infection (MDRI) of 130 days and false recent rate (FRR) of 0% was compared to subtype-specific MDRI and FRR, adjusted to subtype distributions. Results: The observed incidence was 1.05/100 person-years (py) (95%CI 0.90, 1.23) in 2008-09, and 0.66/100 py (95%CI 0.52, 0.83) in 2012-2013. In contrast, the per-protocol LAg-Avidity incidence estimates were 1.63/100 py (95%CI 0.97, 2.30) in 2008-09, and 2.55/100 py (95% CI 1.51, 3.59) in 2012-13 (a significant increase, P<0.05.) However, using a subtype specific MDRI and FRR, the subtype adjusted incidence was 0.88% (95%CI 0.44, 1.33) in 2008-09 and 0.67% (95%CI 0.00, 1.68) in 2012-13, approximating to the observed incidence trends. Conclusions: In this subtype A/D epidemic, the per protocol LAg-Avidity +VL assay overestimated HIV incidence and failed to detect declines in incidence. Adjustment for FRR, MDRI and subtype distribution, provided incidence estimates similar to empirically observed incidence level and trends. Thus, use of the LAg-Avidity assay in an A/D epidemic, requires adjustment for subtype.
copUnited States
pubMary Ann Liebert, Inc
pmid30560723
doi10.1089/AID.2018.0207
oafree_for_read