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

• Published in: Journal of the International AIDS Society Vol. 17; no. 1; pp. 19064 - n/a
• Main Authors: Tchounga, Boris K, Inwoley, Andre, Coffie, Patrick A, Minta, Daouda, Messou, Eugene, Bado, Guillaume, Minga, Albert, Hawerlander, Denise, Kane, Coumba, Eholie, Serge P, Dabis, François, Ekouevi, Didier K
• Format: Journal Article
• Language: English
• Published: Switzerland International AIDS Society 01-01-2014; John Wiley & Sons, Inc
• Subjects: Acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome - diagnosis; Acquired Immunodeficiency Syndrome - virology; Adult; AIDS; Algorithms; Antiretroviral agents; Antiretroviral drugs; Burkina Faso; Care and treatment; classification; Coinfection - diagnosis; Coinfection - virology; Collaboration; Cote d'Ivoire; Cross-Sectional Studies; Data analysis; Deoxyribonucleic acid; Diagnosis; Diagnostic Errors - statistics & numerical data; DNA; Drug resistance; Drug therapy; Examinations; Female; Health screening; HIV; HIV Antibodies - blood; HIV infection; HIV infections; HIV-1 - immunology; HIV-1 - isolation & purification; HIV-2 - immunology; HIV-2 - isolation & purification; HIV‐1&2 dually reactive; HIV‐2; Human immunodeficiency virus; Humans; Immune system; Immunoglobulins; Infections; Internet; Laboratories; Male; Mali; Medical research; Middle Aged; Plasma; Polymerase chain reaction; Precision medicine; Serologic Tests - methods; Short Report; Studies; testing; Validity; West Africa; Mali; Burkina Faso; Cote d'Ivoire; Africa; Côte d'Ivoire; United States > US; West Africa; Abidjan Ivory Coast; Ivory Coast; HIV-1&2 dually reactive; HIV-2; classification; West Africa; testing
• ISSN: 1758-2652; 1758-2652
• DOI: 10.7448/IAS.17.1.19064

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/mm3 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.