Abstract
Objectives:Rapid human immunodeficiency virus (HIV) antibody tests, routinely used for diagnosis in adults and older children in resource-limited settings (RLS), do not detect early HIV infections prior to seroconversion or when antibody levels are still low. Nucleic acid amplification to detect HIV-1 RNA is the most sensitive method for acute HIV infection diagnosis, but is costly. We therefore investigated HIV- 1 RNA testing of pooled dried blood spots (DBS) to diagnose acute HIV infection.Design:Laboratory-based investigation.Methods:DBS were collected from HIV-1 Voluntary Counselling and Testing (HVCT) clients who tested negative on the Advanced QualityTM HIV antibody rapid test. DBS samples from five participants were pooled and tested on the COBAS AmpliPrep/COBAS TaqMan HIV-1 (CAP/CTM) Test v2. Individual DBS were tested when pools tested positive ( 200 RNA copies/ml). Acute infection was confirmed by HIV viral load testing, two fourth-generation HIV serological assays, and Geenius™ HIV 1/2 Assay for antibody band identification.Results:Of 482 participants who were tested, one (0.2%) had acute. HIV infection: Fourth generation serology was low-level positive, the plasma HIV viral load was 15 929 HIV-1 RNA copies/ml, gp160 and gp41 antibody bands were positive and the p31 band was negative, indicating a Fiebig Stage 5 infection.Conclusions: Pooled DBS HIV-1 RNA testing is efficient compared to individual testing for acute HIV infection diagnosis. Early identification of participants with acute HIV infection facilitates immediate initiation of antiretroviral therapy to improve immune recovery and prevent transmission to others.
Highlights
South Africa has the highest burden of tuberculosis/human immunodeficiency virus (TB/HIV) co-infection in the world, with the province of KwaZulu-Natal representing the global epicentre of TB/HIV
While significant progress has been made to improve the diagnosis of pulmonary tuberculosis, the diagnosis of extrapulmonary TB (EPTB) remains a significant challenge in resource-constrained settings
Less than half (42.5%) of the patients were on ART prior to the diagnosis of EPTB
Summary
South Africa has the highest burden of tuberculosis/human immunodeficiency virus (TB/HIV) co-infection in the world, with the province of KwaZulu-Natal representing the global epicentre of TB/HIV. While significant progress has been made to improve the diagnosis of pulmonary tuberculosis, the diagnosis of extrapulmonary TB (EPTB) remains a significant challenge in resource-constrained settings. Methods: A retrospective chart review was conducted, and included all adult patients diagnosed with EPTB at a tertiary hospital in Durban, South Africa, between January 1, 2016 and March 31, 2016. Results: There were 188 new cases of TB during the study period, with 80 patients diagnosed with EPTB. The most common risk factor for EPTB was HIV co-infection (88.8%). In the majority of cases, more than one diagnostic method was used to confirm the presence of TB in distant organs. Conclusion: Immunosuppression, most commonly by HIV, remains the most significant risk factor for the development of EPTB. Despite improved access to antiretroviral therapy over the past years, advanced HIV disease remains a significant challenge to TB control
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