HIV Antibody Research Articles

Factors Associated with HIV Risk Perception Among Cisgender Female Sex Workers in Brazil.

This study evaluated the association between HIV risk perception and sociodemographic and behavioral characteristics among cisgender female sex workers in the five regions of Brazil. A cross-sectional, multicenter study using respondent-driven sampling was used. Sex workers over 18years of age and who reported commercial sex in the past fourmonths were included. All participants completed a questionnaire with sociodemographic and behavioral factors. In addition, the participants were offered a rapid HIV antibody test. Unweighted bivariate analyses and multivariable logistic regression models were used to evaluate the association of sociodemographic and behavioral factors. Overall, 794 HIV-negative participants were included (mean age = 34.44years [SD = 6.49]). Most participants were brown/pardo (59.47%), from social class D-E (82.24%), and with medium education (57.12%). Most women perceived themselves to be at low to moderate risk (68.26%), 7.56% at no risk, and 24.18% at high risk for HIV infection. Those who frequently or always had sexual intercourse under the influence of alcohol had a 2.36 times higher probability of having a high HIV risk perception compared to those who never had sexual intercourse under the influence of alcohol. The data from this study aid in a better understanding of HIV risk perception and its impact on sexual behaviors among female sex workers. Although the majority considered themselves to be at low to moderate risk for HIV, some higher vulnerability behaviors were prevalent.

Prevalence of Anti-HIV Antibodies at 12 Months of Age in Infants Exposed to HIV.

This study determined the prevalence of reactive HIV serology at 12 months of age in infants exposed to HIV in utero. Of the 80 patients analyzed, 50 (63.3%) were anti-HIV reactive. This study suggests that it is probably not helpful to perform HIV antibody testing in HIV-exposed non-breastfed infants who have met virologic criteria to exclude HIV infection in the first year of life.

Current methods for detecting and assessing HIV-1 antibody resistance.

Antiretroviral therapy is the standard treatment for HIV, but it requires daily use and can cause side effects. Despite being available for decades, there are still 1.5 million new infections and 700,000 deaths each year, highlighting the need for better therapies. Broadly neutralizing antibodies (bNAbs), which are highly active against HIV-1, represent a promising new approach and clinical trials have demonstrated the potential of bNAbs in the treatment and prevention of HIV-1 infection. However, HIV-1 antibody resistance (HIVAR) due to variants in the HIV-1 envelope glycoproteins (HIV-1 Env) is not well understood yet and poses a critical problem for the clinical use of bNAbs in treatment. HIVAR also plays an important role in the future development of an HIV-1 vaccine, which will require elicitation of bNAbs to which the circulating strains are sensitive. In recent years, a variety of methods have been developed to detect, characterize and predict HIVAR. Structural analysis of antibody-HIV-1 Env complexes has provided insight into viral residues critical for neutralization, while testing of viruses for antibody susceptibility has verified the impact of some of these residues. In addition, in vitro viral neutralization and adaption assays have shaped our understanding of bNAb susceptibility based on the envelope sequence. Furthermore, in vivo studies in animal models have revealed the rapid emergence of escape variants to mono- or combined bNAb treatments. Finally, similar variants were found in the first clinical trials testing bNAbs for the treatment of HIV-1-infected patients. These structural, in vitro, in vivo and clinical studies have led to the identification and validation of HIVAR for almost all available bNAbs. However, defined assays for the detection of HIVAR in patients are still lacking and for some novel, highly potent and broad-spectrum bNAbs, HIVAR have not been clearly defined. Here, we review currently available approaches for the detection, characterization and prediction of HIVAR.

Antigen affinity and site of immunization dictate B cell recall responses.

Protective antibodies against HIV-1 require unusually high levels of somatic mutations introduced in germinal centers (GCs). To achieve this, a sequential vaccination approach was proposed. Using HIV-1 antibody knockin mice with fate-mapping genes, we examined if antigen affinity affects the outcome of B cell recall responses. Compared to a high-affinity boost, a low-affinity boost resulted in decreased numbers of memory-derived B cells in secondary GCs but with higher average levels of somatic mutations, indicating an affinity threshold for memory B cells to enter GCs. Furthermore, upon boosting local lymph nodes (LNs), the composition of primary GCs was modified in an antigen-affinity-dependent manner to constitute less somatically mutated B cells. Our results demonstrate that antigen affinity and location of the boost affect the outcome of the B cell recall response. These results can help guide the design of vaccine immunogens aiming to selectively engage specific B cell clones for further diversification.

Polyfunctionality and breadth of HIV-1 antibodies are associated with delayed disease progression.

HIV-1 infection leads to chronic disease requiring life-long treatment and therefore alternative therapeutics, a cure and/or a protective vaccine are needed. Antibody-mediated effector functions could have a role in the fight against HIV-1. However, the properties underlying the potential beneficial effects of antibodies during HIV-1 infection are poorly understood. To identify a specific profile of antibody features associated with delayed disease progression, we studied antibody polyfunctionality during untreated HIV-1 infection in the well-documented Amsterdam Cohort Studies. Serum samples were analyzed from untreated individuals with HIV-1 at approximately 6 months (n = 166) and 3 years (n = 382) post-seroconversion (post-SC). A Luminex antibody Fc array was used to profile 15 different Fc features for serum antibodies against 20 different HIV-1 envelope glycoprotein antigens and the resulting data was also compared with data on neutralization breadth. We found that high HIV-1 specific IgG1 levels and low IgG2 and IgG4 levels at 3 years post-SC were associated with delayed disease progression. Moreover, delayed disease progression was associated with a broad and polyfunctional antibody response. Specifically, the capacity to interact with all Fc γ receptors (FcγRs) and C1q, and in particular with FcγRIIa, correlated positively with delayed disease progression. There were strong correlations between antibody Fc features and neutralization breadth and several antibody features that were associated with delayed disease progression were also associated with the development of broad and potent antibody neutralization. In summary, we identified a strong association between broad, polyfunctional antibodies and delayed disease progression. These findings contribute new information for the fight against HIV-1, especially for new antibody-based therapy and cure strategies.

Prevalence of Liver Steatosis Among Workers in Ouagadougou and Associated Factors: A Cross-Sectional Study.

Liver steatosis prevalence is growing, linked to the current worldwide epidemics of obesity and Type 2 diabetes. In sub-Saharan Africa, data on apparent healthy workers must still be included. This study aimed to determine the prevalence of hepatic steatosis and its associated factors in the workplace. A cross-sectional study was conducted from July to October 2022 in seven selected public and private works places in Ouagadougou, Burkina Faso. Workers still in activity were enrolled by random sampling. Sociodemographic and anthropometric characteristics and blood pressure measurements were performed using standard procedures. Blood samples for fasting blood glucose, cholesterol (total, HDL, LDL), triglycerides, transaminases (AST, ALT), gamma-glutamyl-transferase, C reactive protein, uric acid, surface antigen of hepatitis B (HBsAg), antibody to hepatitis C virus (anti-HCV), and HIV antibodies have been realized. Liver steatosis was assessed by FIBROSCAN with controlled attenuation parameter (CAP). An adjusted logistic regression analysis was performed. A significance level of 5% was applied. A total of 500 workers were included in this study. Among them, 293 (58.6%) were men. The prevalence of hepatic steatosis was 18% (95% CI: 14.7-21.7). Factors associated with hepatic steatosis were age over 50 (p = 0.038), waist circumference (p = 0.0001), body mass index (p = 0.008), and cytolysis (p = 0.001). Liver steatosis affects almost a fifth of working people. Health policies must step up the fight against obesity and other nutrition-related noncommunicable diseases.

Prevalence of blood-borne virus infections and uptake of hepatitis C testing and treatment in Australian prisons: the AusHep study

Incarcerated people are at high risk of blood-borne virus infections, particularly HCV, and a priority population for elimination efforts. This national bio-behavioural survey evaluated blood-borne virus prevalence and HCV testing-and-treatment uptake amongst people in Australian prisons. Randomly-selected participants from 23 representative prisons nationally were offered point-of-care testing for HIV and HCV (anti-HCV) antibodies, hepatitis B surface antigen (HBsAg), and HCV RNA (if anti-HCV positive). Demographic data and previous HCV testing and treatment were collected by structured interview. 1599 individuals participated (98% participation; 89%male; median age 35 years; 49% ever injected drugs). Prevalence estimates were: 31.7% (95% CI:28.8-34.8) for anti-HCV; 8.0%for HCV RNA (95% CI:6.4-9.9); 0.5% (95% CI:0.2-1.1) for HBsAg, and 0.8% (95% CI: 0.4-1.7) for HIV antibody. Among participants who had ever injected drugs (n=787), HCV RNA prevalence was highest among those injecting and sharing needles/syringes within the past month [27.9%; adjusted odds ratio (aOR):4.54 (95% CI:2.65-7.77). Among participants (n=1599), 70.4% (95% CI: 67.4-73.2) had ever been tested for HCV (62.6% in prison). The highest likelihood of having had HCV testing was observed among participants who injected drugs in the past month (aOR=10.37, 95% CI:5.72-0.18.78). Among those eligible (n=318), 84.6% (95% CI:79.2-88.7) had ever received HCV treatment (75.0% in prison), and 67.8% (95% CI:61.7-73.4) were cured. The likelihood of HCV treatment was higher among those previously imprisoned, (aOR=2.67, 95% CI:1.20-5.93). Despite high overall HCV testing and treatment uptake, the lower uptake and substantial ongoing HCV disease burden in some sub-populations highlights the need for continued prison-based elimination efforts with population-specific interventions. The AusHep study was funded by the Australian GovernmentDepartment of Health and Aged Care.

False-Positive Human Immunodeficiency Virus-1 Test Results With Rapid Seroreversion After Third-Trimester Tdap Booster Vaccination.

False-positive and false-negative results in human immunodeficiency virus (HIV) testing are expected at some frequency. False-positive results have been reported in association with various conditions, including pregnancy, autoimmune disease, and infection. We present an atypical case of a pregnant patient receiving false-positive HIV results for both screening and antibody confirmatory tests after a recent routine vaccination. A 34-year-old woman, G4P1021, with a negative first-trimester HIV test result received a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) booster at 35 2/7 weeks of gestation. Test results at 36 2/7 weeks of gestation were positive in both HIV-1/2 antigen-antibody screening and a confirmatory HIV-1 antibody differentiation immunoassay, but follow-up test results at 36 5/7 weeks and later were negative. Repeat testing and erythrocyte typing confirmed that this was not a result of laboratory error or specimen mishandling. HIV antiretroviral therapy was started and was later discontinued. A scheduled primary cesarean delivery performed at 39 1/7 weeks of gestation due to breech presentation was uncomplicated. False-positive results in HIV screen and confirmation testing were associated with receipt of a Tdap vaccine booster 7 days prior. This test result pattern is similar to that seen very rarely in previous cases, and the rapid seroreversion to negative suggests an acute immunologic trigger leading to a falsely reactive antibody. Clinicians should be aware of the potential for false-positive HIV test results in patients who recently received vaccination or with other immune triggers and retest at a short interval if suspected.

Can <i>Talaromyces marneffei</i> Infection Cause Acute Liver Failure? A Case Report

Introduction: Talaromyces marneffei is a pathogen that causes talaromycosis, a systemic fungal infection. Cases in which hepatic failure is the primary clinical presentation are exceedingly rare. Case Presentation: This report details the case of a 49-year-old male with no prior liver disease, presenting to the hospital with persistent symptoms, including a fever lasting over ten days, abdominal distension for five days, and jaundice for three days. The patient’s history included immune thrombocytopenia and prolonged glucocorticoid therapy. Physical examination revealed yellowing of the skin and sclera, abdominal distension, firmness of the abdominal wall, absence of abdominal tenderness, positive shifting dullness, and pitting edema in the lumbosacral region and bilateral lower extremities. An HIV antibody test was negative. The patient developed hepatic failure and received artificial liver support along with routine therapy. Despite these interventions, the patient was automatically discharged without improvement and subsequently passed away. Post-discharge, cultures from pleural and abdominal effusions identified Talaromyces marneffei. Conclusions: Talaromyces marneffei infection should be considered in the differential diagnosis of immunocompromised patients, particularly those with no history of liver disease but with long-term glucocorticoid or immunosuppressant use who present with acute liver failure. Early and aggressive investigation for the causative pathogen is essential to minimize diagnostic and treatment delays. Given the prolonged incubation period of Talaromyces marneffei, metagenomic next-generation sequencing may offer a more rapid approach for etiological diagnosis.

EVALUATION OF HEPATITIS A, HEPATITIS B, HEPATITIS C, HIV, MUMPS, MEASLES, RUBELLA, AND VARICELLA IMMUNITY STATUS OF HEALTH SCIENCES STUDENTS

Objective: It is aimed to determine the immunity status of ...University health sciences faculty students against diseases specified in the Turkish Ministry of Health's Health Personnel Screening Protocol for Communicable Diseases. Method: The data of patients who were admitted to …University Family Medicine outpatient clinics between 01.01.2018-31.12.2023, and were tested for at least one of the following tests: HAV antibody (anti-HAV IgG), Hepatitis B surface antigen (HBsAg), antibody against Hepatitis B surface antigen (anti-Hbs), HCV antibody (anti-HCV), HIV antibody (anti-HIV), measles antibody (Measles IgG), mumps antibody (Mumps IgG), rubella antibody (Rubella IgG), varicella antibody (VZV IgG), were retrospectively analyzed. The data of 9051 Health Sciences Faculty students were included in the study. Results: The median age of 9050 students was 22 (min=18, max=30, IQR=2), 6253 (69.10%) were female. While 5 (0.1%) students were HIV-positive, no HCV-positive students were found. The most immunized diseases were Rubella (97%), Varicella (93%), and Hepatitis B (80%); the least immunized disease was Measles (36.9%). AntiHbs and VZV IgG positivity were higher at younger ages (p

Evaluation of the MAGLUMI HIV Ab/Ag combi test for the detection of HIV infection

BackgroundHuman immunodeficiency virus (HIV) infection screening and diagnosis are critical to control the HIV epidemic. Testing for anti-HIV antibodies (Ab) and antigens (Ag) in blood samples is the first step to screen people who have been potentially exposed to the virus. This study aimed to evaluate the performance of the MAGLUMI HIV Ab/Ag Combi for detection of HIV antibodies and antigens.MethodsWe used residual samples to assess the diagnostic specificity and sensitivity of the MAGLUMI HIV Ab/Ag Combi retrospectively. All samples that met the test criteria were tested with the MAGLUMI HIV Ab/Ag Combi according to manufacturer’s instruction. Results of the MAGLUMI HIV Ab/Ag Combi were compared with the Architect HIV Ag/Ab Combo test.ResultsThe specificity of the MAGLUMI HIV Ab/Ag Combi was 99.85% in 5,057 unselected blood donors and 100.00% in 213 hospitalized patient samples, respectively. The sensitivity of the Test in 614 HIV-1 Ab, HIV-1 Ag or HIV-2 Ab positive samples was 100.00%. Seroconversion sensitivity from results of 30 panels was comparable between the MAGLUMI HIV Ab/Ag Combi and the Architect assay.ConclusionsThe reactivity of the MAGLUMI HIV Ab/Ag Combi test is comparable to the Architect HIV Ag/Ab Combo assay.

Fourth-Generation HIV Rapid Tests: Enhanced Sensitivity and Reduced Diagnostic Window for HIV-1 Primary Infection Screening.

As most HIV rapid tests (HRT) detect only HIV-1/2 antibodies, their performance during primary HIV infection is poor. Determine HIV Early detect (Abbott) (Determine) is the only HRT with an HIV-1 p24-antigen detection, but the impact of this addition in shortening the diagnostic window remains unclear. A total of 183 HIV-1 primary infection samples were tested using the HRTs Determine and ONE STEP anti-HIV (1&2) Test (InTec Products) (One-Step). The pre-seroconversion subgroup was defined as p24-antigen positivity without Western blot nor Liaison XL (fouth generation enzyme immunoassay with distinct signal for p24-antigen and HIV-1 antibody) HIV-1 antibodies. Global sensitivity (95% CI) was 95% (91-97) for Determine versus 80% (74%-85%) for One-Step (difference p = 1.38e-06). Pre-seroconversion subgroup sensitivity was lower, at 71.9 (54.6%-84.4%) for Determine and 9.7% (3.3%-24.9%) for One-Step. Among the 45 samples with an HIV-1 infection date, no HRT was reactive up to 2 weeks. Between 2 and 3 weeks, Determine sensitivity was 78% (45%-95%) versus 56% (27%-81%) for One-Step. From 3 weeks to 1 month Determine sensitivity was 90% (62%-98%) and One-Step 45% (21%-72%). The last negative sample occurred at 3 weeks for Determine versus 70-90 days for One-Step. HRT with p24-antigen detection significantly shortens the diagnostic window from approximatively 3 months to 1 month. HRTs should be used with caution in the first month after HIV infection.

Antibodies to HIV-1 gp120 in an experimental model of atherosclerosis caused by immunization with native high-density lipoproteins

Antibodies to bacterial and viral antigens are detected in some systematic autoimmune diseases in the absence of infection. Autoimmune MRL mice and patients with mixed connective tissue disease produce antibodies to gp120 HIV-1, despite the fact that they had never been exposed to HIV-1. Conversely, viral infections may be accompanied by pathological autoimmune reactions. Reactivity to viral antigens in autoimmune diseases and autoimmune reactions in viral diseases are caused by the induction of antibodies via idiotype-anti-idiotype interactions between autoclones and lymphocyte clones against foreign antigens or homology of foreign antigens and autoantigens. Cardiovascular diseases caused by atherosclerosis are currently one of the main causes of mortality in HIV infected patients. It is assumed that HIV infection accelerates atherogenesis. The mechanisms of the association between HIV infection and atherosclerosis are not completely clear. Chronic activation of the immune system, disturbance of cytokine regulation caused by HIV infection, induction of autoantibodies against oxidized low-density lipoproteins (LDL) and antibodies to ApoB-D are considered as possible factors of atherogenesis in HIV infection. The aim of this research was to determine whether an atherogenic immune response against native human high-density lipoproteins (nHDL) could induce antibodies to gp120 HIV-1. Studies were conducted on model of autoimmune atherosclerosis caused by immunization with native human HDL in rabbits. Rabbits (n = 6) were one-time intradermally immunized with human nHDL at a dose of 200 μg of protein per animal in incomplete Freund’s adjuvant. Antibodies to gp120 HIV-1 were measured before immunization of rabbits and on the 28th and 42th day after immunization with HDL, and antibodies to HDL were weekly measured within 42 days after immunization. Histological analysis of the aorta was conducted after eight months after immunization. Transient anti-gp120 HIV-1 antibody production was detected in rabbits immunized with native HDL. The appearance of antibodies to gp120 HIV-1 in response to immunization with native HDL which causes atherosclerosis suggests that the immune response to gp120 HIV-1 during HIV infection may be accompanied by the production of atherogenic antibodies to HDL. Consequently, the antibodies to native lipoproteins caused by an immune response against gp120 HIV-1 may be a factor in atherogenesis during HIV-1 infection.

Mycobacterium terrae Complex Associated Lymphadenitis: Negative AFB PCR

Abstract Introduction/Objective Nontuberculous mycobacteria included with the Mycobacterium terrae complex (MTC) include a ubiquitous, slow-growing collection of mycobacteria known for causing severe resistant skin, joint, and bone infections. There are limited reports of M. Arupensis, included under MTC, causing human infections despite environmental ubiquity. Low sequencing sensitivity for species such as M. Arupensis may result in negative preliminary PCR speciation thus influencing the negative predictive value of this method of organism detection. No prior case reports have described MTC infection presenting as subacute lymphadenitis. Methods/Case Report A 48 year old El Salvadorian male with known diagnosis of HIV presented with oral thrush and significant left-sided lymphadenopathy. He was initially diagnosed with HIV in El Salvador and on ART until immigrating to the US six months prior. HIV antigen and antibody was positive with positive reflex viral PCR. QuantiFERON-TB Gold resulted positive, but CXR was without evidence of pulmonary TB. TB1, TB2, and mitogen minus NIL were negative. He was referred for fine needle aspiration and core needle biopsy of the left cervical lymph node. AFB and AFB FITE stains were performed, but no definitive mycobacteria were identified. GMS was performed and negative for fungal elements. A final histological diagnosis of necrotizing granuloma was given and the tissue was sent for bacterial, AFB, and fungal DNA PCR; no organisms were detected. A sputum sample was obtained and cultured four months after initial presentation and was positive for acid fast bacilli: Mycobacterium terrae complex, most closely resembling Mycobacterium arupensis. The Fite and AFB stains were again reviewed, revealing one single acid fast bacilli organism identified on Fite stain in the necrotizing granuloma. Results (if a Case Study enter NA) N/A Conclusion The negative AFB DNA PCR result may have been a false negative result due to poor sensitivity or selectivity for M. arupensis. There are no former reported cases of M. Arupensis associated necrotizing granulomas in lymph node. This unusual MTC infection presenting as chronic unilateral lymphadenitis underscores the importance of broadening clinical laboratory AFB DNA PCR sensitivity especially in cases of suspected AFB or modified AFB associated necrotizing granulomas.

B-054 Performance Evaluation of the VITROS HIV Combo Assay on the Ortho VITROS 3600 system

Abstract Background n 2014, the US CDC updated HIV screening algorithm, recommended any assay capable of reliably detecting p24 antigen and both IgG&IgM antibodies as starting point. In 2021 Chinese FDA approved VITROS HIV Combo assay as early detection of acute HIV infection with fourth-generation Ag/Ab combination test, with several declared earlier seroconversion panel reactivity than the third generation assay. This study records the experiment run to assess clinical performance using prospectively collected HIV-1 and HIV-2 antibody positive samples from Chinese CDC on the VITROS HIV Combo Assay on the VITROS 5600 Integrated System, Methods In total 450 serum/plasma samples, including 164 HIV antibody positive (162 HIV-1 antibody positive and 2 HIV-2 antibody positive) and 286 HIV negative. The HIV-2 antibody positive samples were purchased from Seracare (United States), and the remaining samples were prepared by the Chinese CDC reference laboratory. In the samples prepared in the reference laboratory, all HIV-1 antibody positive samples were tested by HIV antibody confirmation test, and the result was positive; The HIV negative samples were confirmed based on a comprehensive assessment of HIV antibodies, HIV-1 p24 antigen, HIV nucleic acid testing, and follow-up testing results, and window period has been ruled out. Ten linear and sensitivity reference samples were added to the HIV-1 p24 antigen national reference material (batch number 20190505, purchased from the China Academy of Food and Drug Control) . The antigen concentrations from L1 to L10 were 20, 10, 5, 2.5, 1.25, 0.625, 0.313, 0.156, 0.0781, and 0 IU/ml, respectively. Results The sensitivity for this positive population of samples in the VITROS Combo test was calculated as 100.00% (164/164) with an exact 95% confidence interval (Cl) of 99.26% to 100.00%. The specificity for this negative population was 99.58% (Cl 99.38%-99.73%). Conclusions The sensitivity and specificity of VITROS Combo assay are very high. With class leading antigen sensitivity doesn’t sacrifice specificity. This new assay delivers excellent confidence in results, and with more target (HIV-1 p24) being detected, can helps laboratory shortening HIV infection window, improve operators and technicians’ confidence in the outcome of HIV testing.

A-267 How Does Rapid HIV Antibody Testing Fit Into the Current Testing Algorithm?

Abstract Background Many emergency departments (ED) currently use rapid HIV antibody tests as screening tools, despite limited sensitivity for detecting acute HIV infections. We performed an analysis of standard of care rapid and in-lab fourth generation HIV testing, to 1) assess the performance of rapid HIV testing in our patient population and 2) identify key symptoms of acute HIV infections. Methods A four-year retrospective analysis from 1/1/2018-12/31/2021 was conducted at Barnes Jewish Hospital and St. Louis Children’s Hospital in St. Louis, Missouri. During the study period, both rapid HIV testing (SURE CHECK HIV 1/2, Chembio) and in-lab fourth generation HIV testing (ARCHITECT HIV Ag/Ab Combo Assay, Abbott) were available to providers. Comparative performance of rapid testing and in-lab fourth generation testing was assessed using complete Fourth Generation HIV algorithmic testing as the gold standard. Symptomatology was recorded for a subset of patients that presented to the ED to determine associations with different testing patterns. Results A total of 28,240 rapid HIV antibody tests were administered throughout inpatient, outpatient, and emergency departments at both hospitals, revealing an average yearly positivity rate of 0.6%. In a subset of 1192 patients who underwent both rapid HIV antibody and fourth generation in-lab testing, the rapid HIV antibody test exhibited a positive percent agreement of 92.5% (95% CI: 84.6-96.5) and negative percent agreement of 98.1% (95% CI: 97.1-98.8). Rapid testing demonstrated a negative predictive value (NPV) of 99.5% (95% CI: 98.8-99.8) and a positive predictive value of 77.9% (95% CI: 68.6-85.1). Notably, the rapid test failed to detect 3/3 (100%) acute HIV infections defined as rapid HIV antibody test negative, Ag/Ab assay and nucleic acid amplification assay positive. The rapid test demonstrated comparable performance in patients with known HIV infections, regardless of antiretroviral therapy (ART) status. The positivity rate was 23/24 (95.8%) in known HIV patients with ART compared to 25/27 (92.6%) in those without (P>0.9999). Among patients on ART, the mean ± SD log10 viral load was 3.15±1.52, whereas those without ART exhibited a viral load of 4.87±0.99 (P=0.0140). In the ED, symptoms such as fever, nausea/vomiting, malaise, headache, and photophobia were significantly correlated with acute HIV infection. Acute HIV patients were more likely to display fever in conjunction with three other symptoms (P<0.0001). Conclusions The rapid HIV antibody test demonstrated high sensitivity, specificity, and NPV in our study population, reaffirming its effectiveness as a valuable screening tool. ART did not seem to affect the rapid test performance. However, the low PPV and 100% failure in detecting acute HIV infections underscore the importance of confirmatory in-lab testing. Insights into symptomatology of patients with acute HIV inform ED providers when confirmatory testing is essential for a timely and accurate HIV diagnosis.

Efficacy of Internet Recruitment and HIV Self-Testing for Diagnosing HIV Infections Among Black and Hispanic/Latino MSM and Transgender Women in 11 US States, 2020-2021.

We evaluated internet platforms for distributing HIV self-tests (HIVSTs) to Black or African American (Black) and Hispanic or Latino men who have sex with men (MSM) and transgender women (TGW). We recruited MSM and TGW from general interest, dating, and lesbian, gay, bisexual, and transgender platforms. Two HIVSTs were mailed to all MSM and TGW. Surveys (screening, baseline, 4-month, and results reporting) were completed online. After 4 months, participants were mailed another HIVST and a dried blood spot card. All HIVST interpretations and images of HIVST devices were reported online. Of 2093 MSM and 102 TGW, most were recruited through general interest and dating platforms. Over 50% were 18-29 years old, most identified as gay or bisexual. Overall, 45% had not tested for HIV in the past 12 months, and 9.1% of MSM reported a positive (reactive for HIV antibodies) HIVST result, with the highest percentage among Black MSM (11.5%). Dating platforms recruited higher percentages of MSM who recorded positive results compared with MSM from general interest platforms during the intervention period (11.9% vs 5.5% (P < 0.0001)), and MSM who had never tested for HIV reported a greater percentage of positive HIVST results compared with MSM who had been tested for HIV before enrollment (16.1% vs. 7.1%; P < 0.0001). MSM were able to correctly interpret and report HIVST results. Of TGW, 7% reported a positive HIVST result. Internet dating and general interest platforms can be key to increasing awareness of infection among BMSM, HMSM, and TGW persons, including those who do not use existing HIV services. www.clinicaltrials.gov Identifier: NCT04219878.

HIV and hepatitis C virus infection and co-infection among trans women in San Francisco, 2020.

Transgender women (hereafter "trans women") face social marginalization, stigma, and discrimination and experience a high burden of HIV. More recently, trans women have been identified as having a high risk for hepatitis C (HCV) infection. The interaction between these two diseases and the risks for HIV/HCV co-infection among trans women are understudied. To characterize epidemiological, behavioral, and socio-structural interactions between HIV and HCV infections among trans women. This cross-sectional study examined data from a community-based survey of trans women in San Francisco recruited through respondent-driven sampling (RDS) in 2019/2020. Face-to-face interviews collected data on demographics, medical history, drug injection practices, sexual behavior, and socio-structural factors (e.g., poverty, housing insecurity, incarceration, social support). HIV and HCV antibodies were detected using oral fluid rapid tests and prior diagnosis and treatment were collected by self-report. Blood specimens were collected to confirm antibodies using ELISA. Multinomial logistic regression analysis characterized factors associated with HIV infection alone, HCV infection alone, and HIV/HCV co-infection compared to neither infection. Among 201 trans women recruited, HIV prevalence was 42.3%; HCV infection by history or current seroprevalence was 28.9%; evidence for both HIV and HCV infection was present for 18.9%. Two-thirds of trans women (67.2%) had been incarcerated; 30.8% had ever injected drugs. History of injection drug use and receiving emotional support from family were factors found in common for HIV infection, HCV infection, and HIV/HCV co-infection compared to no infection. Having a sexual partner who injects drugs was associated with HIV infection alone. Not lacking care due to cost and older age were associated with co-infection. Older age was also associated with HCV infection. Of trans women with HIV infection, 91.8% had accessed HIV care, whereas only 62% with HCV had accessed some form of care. Our study found high levels of HIV, HCV, and HIV/HCV co-infection among trans women in San Francisco. We found common associations between HIV and HCV through injection practices and emotional support, but having a sexual partner who injects drugs was not associated with HCV infection alone or co-infection. We note a substantial gap in the treatment of HCV for trans women, including those in HIV care, that needs to be urgently addressed.

Identification of antibody targets associated with lower HIV viral load and viremic control.

High HIV viral loads (VL) are associated with increased morbidity, mortality, and on-going transmission. HIV controllers maintain low VLs in the absence of antiretroviral therapy (ART). We previously used a massively multiplexed antibody profiling assay (VirScan) to compare antibody profiles in HIV controllers and persons living with HIV (PWH) who were virally suppressed on ART. In this report, we used VirScan to evaluate whether antibody reactivity to specific HIV targets and broad reactivity across the HIV genome was associated with VL and controller status 1-2 years after infection. Samples were obtained from participants who acquired HIV infection in a community-randomized trial in Africa that evaluated an integrated strategy for HIV prevention (HPTN 071 PopART). Controller status was determined using VL and antiretroviral (ARV) drug data obtained at the seroconversion visit and 1 year later. Viremic controllers had VLs <2,000 copies/mL at both visits; non-controllers had VLs >2,000 copies/mL at both visits. Both groups had no ARV drugs detected at either visit. VirScan testing was performed at the second HIV-positive visit (1-2 years after HIV infection). The study cohort included 13 viremic controllers and 64 non-controllers. We identified ten clusters of homologous peptides that had high levels of antibody reactivity (three in gag, three in env, two in integrase, one in protease, and one in vpu). Reactivity to 43 peptides (eight unique epitopes) in six of these clusters was associated with lower VL; reactivity to six of the eight epitopes was associated with HIV controller status. Higher aggregate antibody reactivity across the eight epitopes (more epitopes targeted, higher mean reactivity across all epitopes) and across the HIV genome was also associated with lower VL and controller status. We identified HIV antibody targets associated with lower VL and HIV controller status 1-2 years after infection. Robust aggregate responses to these targets and broad antibody reactivity across the HIV genome were also associated with lower VL and controller status. These findings provide novel insights into the relationship between humoral immunity and viral containment that could help inform the design of antibody-based approaches for reducing HIV VL.

Recent and Local HIV Infections among Newly Diagnosed Cases in Two Districts of Chongqing, China (2019–2021)

Newly diagnosed HIV cases often do not clearly indicate whether they are recent or long-standing infections. We collected the history of HIV antibody testing, sexual behavior and initial CD4 + T cell (CD4) count of newly diagnosed HIV/AIDS to determine the time and location of HIV infections. Of the included 612 cases, 17.3% were classified as recent HIV infection. Recent HIV infections were higher in cases aged < 30 (adjusted odds ratio [AOR] = 4.267, 95% Confidence Interval [CI] 1.856–9.813) and 30–49 (AOR = 2.847, 95%CI 1.356–5.977) vs. ≥50, and the transmission mode was men who have sex with men (MSM) (AOR = 4.130, 95%CI 1.815–9.399) was higher than heterosexual contact. Of the 582 cases, 80.8% were classified as local HIV infection (An infection occurred in the two survey districts). Local HIV infections were higher in cases being single and divorced/widowed (AOR = 2.511, 95% CI 1.271–4.962) vs. being married, residing in the survey districts ≥ 5 years (AOR = 168.962, 95%CI 64.942-439.593) vs. < 1 year, transmission mode was MSM (AOR = 8.669, 95%CI 2.668–28.163) vs. heterosexual contact, and acquired infections through spouses or steady partners (AOR = 11.493, 95%CI 3.236–40.819) vs. commercial partners. Both recent and local HIV infections were higher in cases whose transmission mode was MSM, we recommended using internet platforms and MSM dating apps for HIV education and intervention, promoting internet intervention tools to raise awareness about HIV and facilitate early detection.