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p24 revisited: a landscape review of antigen detection for early HIV diagnosis

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Title: p24 revisited: a landscape review of antigen detection for early HIV diagnosis
Authors: Gray, ER
Bain, R
Varsaneux, O
Peeling, RW
Stevens, MM
Mckendry, RA
Item Type: Journal Article
Abstract: Despite major advances in HIV testing, early detection of infection at the point of care (PoC) remains a key challenge. While rapid antibody PoC and laboratory-based nucleic acid amplification tests dominate the diagnostics market, the viral capsid protein p24 is recognized as an alternative early virological biomarker of infection. However, the detection of ultra-low levels of p24 at the PoC has proven challenging. Here we review the landscape of p24-diagnostics to identify knowledge gaps and barriers and help shape future research agendas. 574 research papers to May 2018 that propose or evaluate diagnostic assays for p24 were identified and reviewed. We give a brief history of diagnostic development, and the utility of p24 as a biomarker in different populations such as infants, the newly infected, those on pre-exposure prophylaxis and self-testers. We review the performance of commercial p24 assays and consider elements such as immune complex disruption, resource-poor settings, prevalence, and assay antibodies. Emerging and ultrasensitive assays are reviewed and show a number of promising approaches but further translation has been limited. We summarize studies on the health economic benefits of using antigen testing. Finally, we speculate on the future uses of high performance p24 assays, particularly if available in self-test format.
Issue Date: 24-Sep-2018
Date of Acceptance: 5-Jul-2018
URI: http://hdl.handle.net/10044/1/61992
DOI: https://dx.doi.org/10.1097/QAD.0000000000001982
ISSN: 0269-9370
Publisher: Lippincott, Williams & Wilkins
Start Page: 2089
End Page: 2102
Journal / Book Title: AIDS
Volume: 32
Issue: 15
Copyright Statement: © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal (https://creativecommons.org/licenses/by/4.0/).
Sponsor/Funder: Medical Research Council (MRC)
Engineering & Physical Science Research Council (E
Funder's Grant Number: 538559, MR/P024378/1
EP/K031953/1
Keywords: Science & Technology
Life Sciences & Biomedicine
Immunology
Infectious Diseases
Virology
biomarker
capsid
diagnostic tests
early detection
HIV
point-of-care
HUMAN-IMMUNODEFICIENCY-VIRUS
OF-CARE DIAGNOSTICS
DRIED BLOOD SPOTS
EARLY ANTIRETROVIRAL THERAPY
IMMUNE-COMPLEX DISSOCIATION
4TH GENERATION ASSAYS
COST-EFFECTIVENESS
VIRAL LOAD
TYPE-1 INFECTION
RAPID TEST
Virology
06 Biological Sciences
11 Medical and Health Sciences
17 Psychology and Cognitive Sciences
Publication Status: Published
Conference Place: England
Online Publication Date: 2018-09-24
Appears in Collections:Materials
Faculty of Natural Sciences
Faculty of Engineering