Rapid HIV Antigen–Antibody Assays and Detection of Acute HIV Infection in Sub-Saharan Africa

Adedotun A. Adetunji Department of Family Medicine, University College Hospital, Ibadan, Nigeria;

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Moses O. Adewumi Department of Virology, College of Medicine, University of Ibadan, Ibadan, Nigeria;

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Obaro S. Michael Department of Clinical Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Ibadan, Nigeria;

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Samuel A. Fayemiwo Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan, Ibadan, Nigeria;

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Adesola Ogunniyi Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria;

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Babafemi O. Taiwo Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, Illinois

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Detection of acute HIV infection is a unique problem that fourth-generation HIV assays were expected to alleviate. In this commentary, we draw attention to the limitations and challenges with use of currently available rapid antigen–antibody (Ag/Ab) combination tests for detection of acute HIV infection in sub-Saharan Africa. Laboratory-based HIV-1 Ag/Ab immunoassays are complex, requiring specialized equipment and handling that are currently not affordable in many settings in Africa. The point-of-care Ag/Ab platform on the other hand is easier to deploy and potentially more accessible in resource-limited settings. However, available fourth-generation HIV-1 rapid diagnostic tests have demonstrated poor performance characteristics in field studies where non-B subtypes of HIV-1 dominate. The potential for point-of-care HIV-1 Ag/Ab diagnostics to significantly improve detection of acute HIV infection remains yet to be realized in sub-Saharan Africa. Assay platforms need to be optimized to identify local circulating subtypes, and optimal algorithms need to be determined.

Author Notes

Address correspondence to Adedotun A. Adetunji, Department of Family Medicine, University College Hospital, 1, Queen Elizabeth Rd., Ibadan 200212, Nigeria. E-mail: adedotun_adetunji@yahoo.com

Authors’ addresses: Adedotun A. Adetunji, Department of Family Medicine, University College Hospital, Ibadan, Nigeria, E-mail: adedotun_adetunji@yahoo.com. Moses O. Adewumi, Department of Virology, College of Medicine, University of Ibadan, Ibadan, Nigeria, E-mail: adewumi1@hotmail.com. Obaro S. Michael, Department of Clinical Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Ibadan, Nigeria, E-mail: micobaro@yahoo.com. Samuel A. Fayemiwo, Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan, Ibadan, Nigeria, E-mail: dayteet@yahoo.com. Adesola Ogunniyi, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria, E-mail: aogunniyi53@yahoo.com. Babafemi O. Taiwo, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, E-mail: b-taiwo@northwestern.edu.

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