HIV serologic reactivity varies with time of ART initiation in persons on long-term ART
Bibliographic record
Abstract
HIV serologic responses measured by clinical screening assays may be blunted when antiretroviral treatment (ART) suppresses HIV replication from the initial infection stages, with further decay following long-term treatment. Sensitivity may vary according to the timing of ART initiation after HIV acquisition, antigens (Ags) utilized to detect anti-HIV antibodies (Abs), and HIV subtype. We obtained samples from long-term ART-suppressed persons with HIV (PWH) who started ART at acute/early or during chronic infection, from blood donors with undetectable HIV RNA and nonreactive serology, and from blood donors with positive RNA and reactive serology (presumably untreated infections) spanning multiple HIV subtypes to compare patterns of serologic reactivity using two Ag/Ab screening assays (Alinity and VITROS). We found that earlier ART initiation was associated with progressively lower signal-to-cutoff ratios (S/CO) in both assays. Serologic reactivity in clinical samples from participants initiating ART at Fiebig 2 was somewhat lower for CRF01_AE (67%) than other HIV subtypes (91%) on the Alinity platform. In the late-ART initiation group, reactivity was high for both assays despite long-term treatment, with higher S/CO values in samples from blood donors with presumably untreated infection. We observed no strong evidence of S/CO waning >96 weeks after ART initiation in the early-ART initiation group. Our findings suggest potential limitations for HIV infection ascertainment in clinical samples from long-term treated PWH who started ART at early infection stages using currently approved serologic tests.IMPORTANCEThis manuscript increases our understanding of how the timing of initiation of HIV treatment affects our ability to detect the infection using commercial blood tests that measure HIV antigens or antibodies. Being able to detect HIV is important for clinical diagnostics and blood screening, and HIV is not as easily detected in persons who begin therapy shortly after infection using serological tests. In contrast to prior work, we show that current clinical HIV tests have stable reactivity over time in persons on long-term HIV treatment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".