Minimal residual HIV viremia: verification of the Abbott Real-Time HIV-1 assay sensitivity

Introduction: In the HIV-1 infection, the increase in number of CD4 T lymphocytes and the viral load decline are the main indicators of the effectiveness of antiretroviral therapy. On average, 85% of patients receiving effective treatment has a persistent suppression of plasma viral load below the detection limit (<50 copies/mL) of clinically used viral load assays, regardless of treatment regimen in use. It is known, however, that, even when viremia is reduced below the sensitivity limit of current diagnostic assays, the virus persists in “reservoirs” and traces of free virions can be detected in plasma.There is a considerable interest to investigate the clinical significance of residual viremia. Advances in molecular diagnostics allows nowadays to couple a wide dynamic range to a high sensitivity.The Abbott Real-time HIV-1 test is linear from 40 to 107 copies/mL and provides, below 40 copies/mL, additional information such as “<40cp/mL, target detected” or “target not detected”. The HIV-1 detection is verified by the max-Ratio algorithm software.We assessed the test sensitivity when the qualitative response is considered as well. Methods: A ‘probit’ analysis was performed using dilutions of the HIV-1 RNA Working Reagent 1 for NAT assays (NIBSC code: 99/634), defined in IU/mL and different from that used by the manufacturer (VQA,Virology Quality Assurance Laboratory of the AIDS Clinical Trial Group) for standardization and definition of performances.The sample input volume (0.6 mL) was the same used in clinical routine. A total of 196 replicates at concentrations decreasing from 120 to 5 copies/mL, in three different sessions, have been tested.The ‘probit’ analysis (binomial dose-response model, 95% “hit-rate”) has been carried out on the SAS 9.1.3 software package. Results: The sensitivity of the “<40cp/mL, target detected” response was equal to 28,76 copies/mL, with 95% confidence limits between 22,19 and 52,27 copies/mL. Conclusions: With the protocol of 0.6 mL, the Abbott RealTime test is able to detect viral concentrations down to 29 copies/mL. A further sensitivity increase below the current threshold is likely to be reached through the adoption of experimental protocols based on increased input volumes in order to improve significantly assay precision at low viremia level.