Abstract
Background: New challenges for diagnosis of HIV infection abound, including the impact on key viral and immunological markers of HIV vaccine studies, pre-exposure prophylaxis usage and breakthrough infections, and very early initiation of anti-retroviral treatment. These challenges impact the performance of current diagnostic assays, and require suitable specimens for development and evaluation. In this article we review and describe an archive developed by the Consortium for the Evaluation and Performance of HIV Incidence Assays (CEPHIA), in order to identify the critical features required to create a centralized specimen archive to support these current and future developments. Review and Findings: We review and describe the CEPHIA repository, a large, consolidated repository comprised of over 31,000 highly-selected plasma samples and other body fluid specimen types, with over 50 purposely designed specimen panels distributed to 19 groups since 2012. The CEPHIA repository provided financial return on investment, supported the standardization of HIV incidence assays, and informed guidance and standards set by the World Health Organization and UNAIDS. Unified data from extensively characterized specimens has allowed this resource to support biomarker discovery, assay optimization, and development of new strategies for estimating duration of HIV infection. Critical features of a high-value repository include 1) extensively-characterized samples, 2) high-quality clinical background data, 3) multiple collaborations facilitating ongoing sample replenishment, and 4) sustained history of high-level specimen utilization. Conclusion: With strong governance and leadership, a large consolidated archive of samples from multiple studies provides investigators and assay developers with easy access to diverse samples designed to address challenges associated with HIV diagnosis, helping to enable improvements to HIV diagnostic assays and ultimately elimination of HIV. Its creation and ongoing utilization should compel funders, institutions and researchers to address and improve upon current approaches to sharing specimens.
Highlights
Over the past three decades, archived HIV samples have allowed commercial and academic researchers to develop and evaluate multiple new HIV assays and HIV diagnostic strategies, including new approaches to measure and monitor HIV prevalence and incidence[1,2]
Despite having a reputation as expensive white elephants, our review highlights that specimen repositories can play an invaluable role in the development, optimization, and validation of diagnostic assays
Developing the archive required overcoming a number of significant challenges, and despite its demonstrated value given the financial investment, lack of consistent funding threatens the existence of the CEPHIA repository and the collaborative team that supports its use
Summary
Over the past three decades, archived HIV samples have allowed commercial and academic researchers to develop and evaluate multiple new HIV assays and HIV diagnostic strategies, including new approaches to measure and monitor HIV prevalence and incidence[1,2] This has allowed us to achieve improved sensitivity and specificity of assays with reduced time to detect infection following HIV acquisition[3,4,5,6,7,8], attain an increased range of incidence and prognostic biomarkers[9,10,11], advance techniques for identification of diverse HIV genotypes and recombinant viruses as well as prediction of drug resistance[12,13,14,15,16,17,18], and automate and increase throughput of diagnostic platforms[19,20]. R eplenishment of the archive as specimens are utilized, while maintaining consistency across standard panels available to researchers and assay developers
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