Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
1
Agenda
2
ARCHITECT® HIV Ag/Ab Combo
Chemiluminescent microparticle immunoassay for in vitro diagnostic use.
Simultaneous qualitative detection of HIV p24 antigen and antibodies to
HIV-1 group M and group O and/or HIV-2 in human serum and plasma
(EDTA and heparin)
Intended to be used as an aid in the diagnosis of HIV-1/HIV-2 infection,
including acute or primary infection
An ARCHITECT HIV Ag/Ab Combo reactive result does
not distinguish between the detection of HIV-1 p24 antigen, HIV-1
antibody, or HIV-2 antibody
May be used to aid in the diagnosis of HIV-1/HIV-2 infection in pediatric
subjects (i.e. children as young as 2 years of age) and in pregnant woman
Not intended for use in screening blood or plasma donors. However can
be used as a blood donor screening assay in urgent situations where
traditional licensed blood donor screening assays are unavailable or their
use is impractical
3
ARCHITECT Instrument
Fully-automated, random-access
(no Control brackets)
Stat capability
HIV Combo assay:
29 minute time to first result
>150 tests per hour on i2000SR
>50 tests per hour on i1000SR
4
ARCHITECT HIV Ag/Ab Combo
5
What is Acute Phase of HIV Infection?
Appearance of markers of HIV infection
AHI
HIV RNA
(plasma)
Anti-HIV Ab
HIV p24 Ag
0 10 20 30 40 50 60 70 80 90 100
Day post infection
6
Why is Detection of AHI Important?
7
HIV Combo Acute HIV Infection Studies
8
Acute HIV Infection Studies
9
Seattle Study
Stekler JD, et al, Clin Infectious Diseases 2009; 49:444-453
10
Seattle Combo Results
11
Seattle Conclusions
12
ARCHITECT HIV Combo Detects Acute HIV Infections
# AHI Combo # AHI Combo
Site
tested detected
Seattle (Stekler, CID 2009; 49:444-453) 16 15 (94%)
CDC AHI Study (Patel, Arch Int Med 2010; 170:66-74) 38 34 (89%)
14
Reduction in Seroconversion Window Period
Anti-HIV Ab
HIV p24 Ag
0 10 20 30 40 50 60 70 80 90 100
Day post infection
1st Gen Ab
35
3rd Gen Ab
22
4th Gen Ag/Ab
17
Fiebig et al, AIDS 2003; 17:1871-1879 Owen et al, J Clin Micro 2008; 46:1588-1595
Kleinman et al, Transfusion 2009; 49:2454-2489 Patel et al, Arch Int Med 2010; 170:66-74
15
Erie County Medical Center Buffalo, NY:
Increased HIV Testing and Identification of AHI
Implementation of NYS law resulted in 5-fold increase in HIV
tests performed
Tested 3601 patients w/ ARCHITECT HIV Combo assay:
31 confirmed HIV infections (0.9%)
6 newly diagnosed chronic HIV infections
1 diagnosed acute HIV infection
Specificity: 99.92%
AHI case:
37 year old with acute viral syndrome came to emergency room
Reactive for HIV: ARCHITECT HIV Combo, HIV-1 RNA
Nonreactive for HIV: 3rd generation EIA, rapid test, western blot
Myers JB, et al., 27th Clinical Virology Symposium, May 2011, Daytona Beach FL
16
ARCHITECT HIV Combo: The U.S. Experience
Dallas-Fort Worth, TX
Tested 220 specimens from patients being screened for HIV
Compare ARCHITECT Combo to comparator tests
Combo detected 4 AHI not detected by comparator plus 1 recent
infection with indeterminant Western blot
Dr L Serrano, Abbott Workshop, AACC 2011.
Wians FH, et al., Labmedicine (2011) 42:523-535.
17
ARCHITECT HIV Ag/Ab Combo: Conclusions
HIV Combo detects HIV infections during the acute, recent, and
established phases of infection.
Substantial improvement over HIV Ab immunoassays
Sensitive Ag and Ab detection across HIV subtypes/groups
High specificity (reduced cost associated with false-positives)
Fully automated, random access, high through-put
Time to first result: 29 minutes
Early implementation of ARCHITECT HIV Combo assay has
demonstrated benefits of the assay both high and low prevalence
settings
18
Publications on ARCHITECT HIV Combo
1. Ly TD, et al, J Virol Meth 2007, 143:86-94. Could the new HIV combined p24 antigen and antibody
assays replace p24 antigen specific assays?
2. Pandori MW, et al, J Clin Micro 2009, 47:2639-2642. Assessment of the ability of a fourth-generation
immunoassay for human immunodeficiency virus (HIV) antibody and p24 antigen to detect both acute
and recent HIV infections in a high risk setting.
3. Stekler JD, et al Clin Infect Dis 2009, 49:444-453. HIV testing in a high incidence population: is
antibody testing alone good enough?
4. Eshleman SH, et al, J Acquir Immune Defic Syndr 2009, 52:121-124. Detection of individuals with
acute HIV-1 infections using the ARCHITECT HIV Ag/Ab Combo assay.
5. Patel P, et al, Arch Intern Med 2010, 170:66-74. Detecting acute human immunodeficiency virus
infection using 3 different screening immunoassays and nucleic acid amplification testing for human
immunodeficiency virus RNA, 2006-2008.
6. Bischof JJ, et al AIDS 2011, 25:1927-1929. Prospective study of the ARCHITECT HIV Ag/Ab Combo
4th generation assay to detect HIV infection in STI clinics.
7. Wians FH, et al, Labmedicine 2011, 42:523-535. Evaluation of four qualitative third-generation HIV
antibody assays and the fourth-generation Abbott HIV Ag/Ab Combo test.
8. Masciotra S, et al, J Clin Virol 2011, dio:10.1016/j.jcv.2011.09.011. Evaluation of alternative HIV
diagnostic algorithm using specimens from seroconversion panels and persons with established HIV
infections.
B. Branson, CDC: APHL Webcast, Nov 15, 2011: HIV Diagnostics: New Tests and New Algorithms
19