Shilpa Iyer, MS, PhD

GHES U.S. Fellow 2017-2018

Fellowship Site: Centre for Infectious Disease, Zambia
U.S. Institution: Yale University

Project Title: Identification of acute HIV-1 infection using a novel, 4th generation, point-of-care diagnostic test in Lusaka, Zambia

Increases in the HIV burden are an immense global health problem, and methods to curb incidence are of critical importance. As of 2016, 1.2 million people live with HIV in Zambia, with 60,000 new infections annually. Individuals with acute HIV infection (AHI) disproportionately contribute to the spread of HIV when compared to chronically infected individuals, largely due to higher viral loads and increased infectivity of acute viruses. Recent WHO guidelines recommend the initiation of antiretroviral therapy (ART) upon the confirmation of HIV infection. Thus, the identification of individuals with AHI and ART initiation could reduce onward transmission by reducing the plasma viremia of the HIV positive individual. AHI is characterized by the presence of viral RNA and/or antigen, but absence of virus-specific antibodies standard of care (SOC) rapid tests cannot identify individuals with AHI, and in many instances fail to diagnose cases of established infection. Thus, an accessible diagnostic method is required to identify cases of AHI.

In this study, we propose to identify individuals with AHI and determine the false negative rate of the SOC using Alere HIV Combo- an affordable, point of care 4thgeneration immunoassay that simultaneously detects antigen and antibodies. In addition, ART initiation of individuals with AHI could be beneficial in reducing transmission and help in reaching the 90-90-90 UNAIDS target and assist in curbing HIV incidence. Our study aims are to identify patients with AHI followed by immediate initiation of ART, determine the feasibility of using Alere HIV combo to identify AHI and determine the false negative rate of the SOC.