Mel Krajden

University of British Columbia - Vancouver, Vancouver, British Columbia, Canada

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Publications (195)848.1 Total impact

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    ABSTRACT: Improved surveillance methods are needed to better understand the current Hepatitis C virus (HCV) disease burden and to monitor the impact of prevention and treatment interventions on HCV transmission dynamics. Sanger sequencing (HCV NS5B, HVR1 and Core-E1-HVR1) and phylogenetics were applied to samples from individuals diagnosed with HCV in British Columbia, Canada in 2011. This included individuals with two or three sequential samples collected < 1 year apart. Patristic distances between sequential samples were used to set cutoffs to identify recent transmission clusters. Factors associated with transmission clustering were analyzed using logistic regression. From 618 individuals, 646 sequences were obtained. Depending on the cutoff used, 63 (10%) to 92 (15%) unique individuals were identified within transmission clusters of predicted recent origin. Clustered individuals were more likely to be <40 years old (Adjusted Odds Ratio (AOR) 2.12, 95% CI 1.21 - 3.73), infected with genotype 1a (AOR 6.60, 95% CI 1.98 - 41.0), and to be seroconverters with estimated infection duration of <1 year (AOR 3.13, 95% CI 1.29 - 7.36) or >1 year (AOR 2.19, 95% CI 1.22 - 3.97). Systematic application of molecular phylogenetics may be used to enhance traditional surveillance methods through identification of recent transmission clusters. Copyright © 2015. Published by Elsevier B.V.
    Infection, genetics and evolution: journal of molecular epidemiology and evolutionary genetics in infectious diseases 04/2015; DOI:10.1016/j.meegid.2015.04.017 · 3.26 Impact Factor
  • The Journal of Infectious Diseases 03/2015; DOI:10.1093/infdis/jiv177 · 5.78 Impact Factor
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    ABSTRACT: We report on the rates of cervical dysplasia in young women aged 15 to 22 years of age in British Columbia before and after the introduction of an HPV vaccine program. Rates of cervical intraepithelial neoplasia (CIN) 2+ for each age stratum (15-22) in the calendar years 2004-2012 for the province of British Columbia were obtained from the BC Cancer Agency's population-based cervical cancer program. Incidence rate ratios (IRR) of CIN2+ were described and compared before and after HPV vaccine program introduction in cohorts born in vaccine eligible years, and in non-vaccine eligible years using piece-wise Poisson regression analysis, and adjusted for age. Between 2004 and 2012, rates of CIN2 and CIN2+ in young women aged 15 to 22 in the province of British Columbia have decreased overall. After the introduction of the HPV vaccine program, the age adjusted IRR for CIN2+ for girls aged 15-17 decreased significantly from 0.91 (95%CI: 0.86; 0.98 p<0.01) to 0.36 (95%CI: 0.18; 0.73 p<0.01). During the same time period, no similar reduction was found in young women 18 to 22. After introduction of HPV vaccine program, IRR for CIN2+ in girls 15-17 was significantly reduced for CIN2+ (0.14; 95%CI 0.04, 0.47; p<0.01) and CIN2 (0.1; 95% CI 0.02, 0.54; p<0.01). This ecological analysis shows a significant reduction in CIN2+ lesions in young women aged 15 to 17 in British Columbia after the introduction of the HPV vaccine in girls despite vaccine uptake levels below 70%. This article is protected by copyright. All rights reserved. © 2015 UICC.
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    ABSTRACT: The recent emergence of severe respiratory disease by enterovirus D68 prompted investigation into whether Canadian hospital and provincial laboratories can detect this virus using commercial and laboratory developed assays. This study demonstrated analytical sensitivity differences between both commercial and laboratory developed assays for the detection of enterovirus D68. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
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    ABSTRACT: We described trends for sexually transmitted infections (STI) among gay/bisexual men in British Columbia, Canada, using a sentinel site surveillance approach. Using data from an electronic charting system, we included gay/bisexual men who visited high-volume STI clinics from 2000 to 2013. Diagnosis rates and incidence density were calculated for chlamydia, gonorrhea, syphilis, HIV, hepatitis C, genital herpes, and genital warts. Incidence density was estimated among repeat testers who converted from a negative to positive test result. We also conducted Poisson regression analysis to determine factors that were associated with increased incidence rates. A total of 47,170 visits were identified for gay/bisexual men during our time frame. The median age was 34 years (interquartile range, 27-43 years), and most clients were seen in Vancouver. Although trends for most STI were stable, diagnoses of gonorrhea and syphilis have risen steadily in recent years. Coinfection with HIV was associated with higher gonorrhea and syphilis rates in the Poisson regression model. In addition, visiting a Vancouver clinic and younger age were associated with increased incidence. Our clinic-based sentinel surveillance system found increasing trends for gonorrhea and syphilis among gay/bisexual men but not for other STI in British Columbia. Further investigation is required to explore the syndemic effects of syphilis, gonorrhea, and HIV. This new platform will be a valuable tool for ongoing monitoring of STI and targeting prevention efforts.
    Sex Transm Dis 03/2015; 42(3):153-159. DOI:10.1097/OLQ.0000000000000250 · 2.75 Impact Factor
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    ABSTRACT: https://www.youtube.com/watch?v=ildNgHHKPaU&list=PLy0zwf7_pKrUGWZ-WibwZYC_z4MX5m2O1
    4th Canadian Symposium on HCV, Banff, AB, Canada; 02/2015
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    ABSTRACT: Abstract Background: Enterovirus D68 (EV-D68) has been detected infrequently and has not been associated with severe disease in Canada. In the early fall of 2014, following an unusual case increase in the United States, clusters of EV-D68 among children and some adults manifesting severe symptoms were reported in Canada. Objective: To provide an initial epidemiological summary of pediatric cases hospitalized with EV-D68 in Canada. Methods: A time-limited surveillance pilot was conducted collecting information on pediatric cases (less than 18 years of age) hospitalized with EV-D68 between September 1 and 30, 2014. Results: In total, 268 cases were reported from Ontario (n=210), Alberta (n=45), and British Columbia (n=13). Of the 268 reported cases, 64.9% (n=174) were male; the sex difference was statistically significant (p<0.01). Age was reported for 255 cases, with a mean age for males of 5.4 years and for females of 5.3 years. For cases with data available, 6.8% (18/266) were admitted to an intensive care unit. Of those where clinical illness was recorded, respiratory illness alone was present in 98.3% (227/231), neurologic illness alone was present in 0.4% (n=1), and both illnesses were present in 0.9% of cases (n=2); cases with neither respiratory nor neurologic illness were rare (n=1). Of the 90 cases with additional clinical information available, 43.3% were reported as having asthma. No deaths were reported among the 268 cases. Conclusion: The EV-D68 outbreak in Canada in September 2014 represents the beginning of a novel outbreak associated with severe illness in children. These findings provide the first epidemiological summary of severe cases of EV-D68 as an emergent respiratory pathogen in Canada. The continued investigation of this pathogen is necessary to build on these results and capture the full spectrum of associated illness.
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    ABSTRACT: Context Hepatitis C virus (HCV) infection is an important cause of progressive liver disease. It is spread through blood-to-blood contact and seldom produces symptoms at the time of infection. Three of four infections become chronic and, over decades, 15% to 30% of those infected develop cirrhosis, hepatocellular cancer, or require liver transplantation.[1] An estimated 230 000 to 450 000 (0.66% to 1.3%) of Canadians are infected with HCV.[2] In British Columbia, approximately 80 000 people have been diagnosed with HCV and many are unaware of their HCV status. Two of three HCV-infected individuals in BC are baby boomers born between 1945 and 1965, and many are now presenting with end-stage liver disease. Most new infections occur in people who inject drugs. Other HCV-affected populations include immigrants from HCV-endemic countries and Aboriginal people.[3] The Public Health Agency of Canada recommends screening these groups at least once.[4] Others, including the Canadian Liver Foundation, also recommend screening people born between 1945 and 1975.[5] Care and treatment Treatment and self-care, including reducing alcohol intake, can prevent progressive liver disease and improve quality of life. Treatment of HCV is shifting from older, poorly tolerated interferon-based therapies, which cure approximately 55% of those treated (45% for genotype 1, 60% to 70% for genotype 3, and 70% to 80% for genotype 2)[6] to new well-tolerated, short-course (8 to 12 weeks) interferon-free direct-acting antiviral drugs with cure rates approaching more than 95%.[7] The simplicity and tolerability of newer treatments opens the opportunity for HCV treatment to be delivered by primary care physicians, thus increasing treatment capacity. However, treatment can only occur if undiagnosed people get tested, and diagnosed people are engaged into care. Resources Our research identified several patient, provider, and health care system related factors associated with nonattendance for HCV care.[8] A website was designed to address some of these factors (www.hepatitiseducation.ca). The website employs a navigation hub outlining key topics along the cascade of care to support consumers and providers. These linguistically and culturally appropriate resources include basic facts about HCV, the testing process, being diagnosed, living with HCV, and treatment, and can assist providers in supporting patient information needs across the cascade of HCV care. Resources are available in English and French, have been adapted for Aboriginal and Inuit populations, and are being adapted to Punjabi and other languages. To maximize accessibility and engagement, information is presented via videos, online courses, downloadable booklets, cards, and printable materials. Summary HCV affects a large number of British Columbians and many are unaware that they are infected. Highly effective, well-tolerated, short-course curative treatments are becoming available, but for treatments to be effective people must be diagnosed and engaged into care and treatment. The illustrated and narrated education and support resources are intended to support the information needs of patients and providers related to screening, diagnosis, care, and treatment.
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    ABSTRACT: The ability to classify acute vs. chronic hepatitis C virus (HCV) infections at the time of diagnosis is desirable to improve the quality of surveillance information. The aim of this study was to differentiate acute from chronic HCV infections utilizing deep sequencing. HCV NS5B amplicons (n=94) were generated from 77 individuals (13 acute and 64 chronic HCV infections) in British Columbia, Canada with documented seroconversion timeframes. Amplicons were deep sequenced and HCV genomic diversity was measured by Shannon entropy (SE) and a single nucleotide variant (SNV) analysis. The relationship between each diversity measure and the estimated days since infection was assessed using linear mixed models and the ability of each diversity measure to differentiate acute from chronic infections was assessed using generalized estimating equations. Both SE and the SNV diversity measures were significantly different for acute vs. chronic infections (p <0.009). NS5B nucleotide diversity continued to increase for at least 3 years post-infection. Among individuals with the least uncertainty with regard to duration of infection (n=39), the area under the receiver operating characteristic curve (AUROC) was high (0.96 for SE; 0.98 for SNV). Although the AUROCs were lower (0.80 for SNV; 0.86 for SE) when data for all individuals were included, they remain sufficiently high for epidemiological purposes. Synonymous mutations were the primary discriminatory variable accounting for over 78% of the measured genetic diversity. Conclusions: NS5B sequence diversity assessed by deep sequencing can differentiate acute from chronic HCV infections and with further validation could become a powerful population level surveillance tool for incidence estimation.Approximately 184 million people worldwide have been infected with hepatitis C virus (HCV) (1), including an estimated 138,600 – 221,300 people in Canada (2). About 75% develop chronic infection and the remaining 25% clear infection spontaneously (3). Without treatment, 15% to 25% of those chronically infected will develop progressive liver disease over several decades. Fortunately, HCV can be virologically cured, which reduces all-cause and liver-related mortality (4) and newer well-tolerated direct acting antiviral treatments hold the promise of curing >95% of infections (5). This article is protected by copyright. All rights reserved.
    Hepatology 02/2015; DOI:10.1002/hep.27734 · 11.19 Impact Factor
  • Eurosurveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin 01/2015; 20(4). · 4.66 Impact Factor
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    ABSTRACT: Hepatitis C virus (HCV) has a naturally-occurring polymorphism Q80 K in the NS3 gene encoding the viral protease, which has been associated with reduced susceptibility to the direct-acting antiviral inhibitor Simeprevir. Q80 K is observed predominantly in genotype 1a, and seldom in other HCV genotypes; moreover, it has a markedly high prevalence in the United States. Here, we reconstruct the evolutionary history of this polymorphism to investigate why it is so highly localized in prevalence, and whether it is stably transmitted between hosts. We find the majority (96%) of HCV infections carrying Q80 K were descended from a single lineage in which a Q80 K substitution occurred around the 1940's in the United States, which implies that this polymorphism is likely highly transmissible. Furthermore, we identified two other substitutions in NS3 that may interact with Q80 K and contribute to its stability. Our results imply that the current distribution and prevalence of Q80 K are unlikely to change significantly in the short term.
    The Journal of Infectious Diseases 11/2014; DOI:10.1093/infdis/jiu613 · 5.78 Impact Factor
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    ABSTRACT: Introduction: Individuals living in single-room occupancy (SRO) hotels constitute a socially marginalized group with exposure to multiple factors with adverse effects on neurocognition, including substance use, viral infection, psychiatric illness, and brain injury. Consequently, marked heterogeneity in neurocognitive functioning is observed. This study aimed to identify and describe distinct neurocognitive profiles within a marginally housed sample. Method: Two hundred and forty-nine (N = 249) SRO hotel residents (mean age = 43.5 years) were recruited. A battery of tests assessed neurocognition across six domains: premorbid IQ, verbal memory, attention, inhibition, mental flexibility, and decision making. Clinical examinations collected information pertaining to substance use and psychiatric diagnoses, viral infection, psychiatric symptoms, risk behaviors, and everyday functioning. Cluster analysis was used to identify subgroups of individuals with similar neurocognitive profiles and was supplemented with a discriminant function analysis. Analyses of variance and chi-square tests were used to validate the derived clusters on key clinical and functional variables. Results: A three-cluster solution was found to be optimal. Cluster 1 (n = 59) presented as overall higher functioning, whereas Cluster 3 (n = 87) exhibited overall lower functioning with a relative strength in decision-making skills. Cluster 2 (n = 103) was characterized by neurocognitive abilities that generally bisected the performance of the other groups, but with a relative weakness in decision-making skills. Discriminant function analysis indicated the six neurocognitive variables comprised two underlying dimensions that accounted for between-group variance. Clusters meaningfully differed on demographics, substance use, viral exposure, psychiatric symptoms, neurological soft signs, and risk behavior. Conclusion: Neurocognitive functioning provides the basis for identifying meaningful subgroups of marginally housed individuals, which can be reliably differentiated on key variables. This approach facilitates an understanding of the neurocognitive dysfunction and associated vulnerabilities of marginalized persons and ultimately may elucidate intervention targets.
    Journal of Clinical and Experimental Neuropsychology 11/2014; DOI:10.1080/13803395.2014.963519 · 2.16 Impact Factor
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    ABSTRACT: Perinatal transmission of hepatitis B virus (HBV) can occur despite postexposure prophylaxis (PEP). Recent literature suggests that antiviral treatment during pregnancy when maternal HBV DNA levels are elevated can further decrease vertical transmission. However, HBV DNA screening is not routinely performed antenatally.
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    ABSTRACT: This case series describes morbilliform and other rash presentations among schoolchildren during a March 2014 outbreak of influenza-like illness (ILI) in British Columbia, Canada. Multiplex nucleic acid testing of nasopharyngeal specimens and paired serologic investigations identified that influenza B, characterized as B/Massachusetts/02/2012-like (Yamagata-lineage), was the only viral aetiology and most likely cause of ILI and rash. An association between influenza B and rash has been described infrequently elsewhere, and not previously in North America. Influenza B should be considered in the differential diagnosis of febrile exanthem. Evaluation of the nature, incidence and contributing agent–host–environment interactions, and immunologic mechanisms to possibly explain influenza-associated rash is warranted.
    Influenza and Other Respiratory Viruses 11/2014; 9(1). DOI:10.1111/irv.12296 · 1.90 Impact Factor
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    ABSTRACT: Little is known about factors associated with HCV transmission among people who inject drugs (PWID). Phylogenetic clustering and associated factors were evaluated among PWID in Vancouver, Canada. Data were derived from the Vancouver Injection Drug Users Study. Participants who were HCV antibody positive at enrolment and those with HCV antibody seroconversion during follow-up (1996 to 2012) were tested for HCV RNA and sequenced (Core-E2 region). Phylogenetic trees were inferred using maximum likelihood analysis and clusters were identified using ClusterPicker (90% bootstrap threshold, 0.05 genetic distance threshold). Factors associated with clustering were assessed using logistic regression. Among 655 eligible participants, HCV genotype prevalence was: G1a: 48% (n=313), G1b: 6% (n=41), G2a: 3% (n=20), G2b: 7% (n=46), G3a: 33% (n=213), G4a: <1% (n=4), G6a: 1% (n=8), G6e: <1% (n=1) and unclassifiable: 1% (n=9). The mean age was 36 years, 162 (25%) were female and 164 (25%) were HIV+. Among 501 participants with HCV G1a and G3a, 31% (n=156) were in a pair/cluster. Factors independently associated with phylogenetic clustering included: age <40 (vs. age ≥40, adjusted odds ratio [AOR] = 1.64; 95% CI 1.03, 2.63), HIV infection (AOR = 1.82; 95% CI 1.18, 2.81), HCV seroconversion (AOR = 3.05; 95% CI 1.40, 6.66) and recent syringe borrowing (AOR 1.59; 95% CI 1.07, 2.36). Conclusion: In this sample of PWID, one-third demonstrated phylogenetic clustering. Factors independently associated with phylogenetic clustering included younger age, recent HCV seroconversion, prevalent HIV infection, and recent syringe borrowing. Strategies to enhance the delivery of prevention and/or treatment strategies to those with HIV and recent HCV seroconversion should be explored, given an increased likelihood of HCV transmission in these sub-populations.3 (Hepatology 2014;)
    Hepatology 11/2014; 60(5). DOI:10.1002/hep.27310 · 11.19 Impact Factor
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    ABSTRACT: Mounting evidence affirms HPV testing as an effective cervical cancer screening tool, and many organized screening programs are considering adopting it as primary testing. HPV self-collection has comparable sensitivity to clinician collected specimens and is considered a feasible option in hard-to-reach women. We explored women's intentions to HPV self-collect for cervical cancer screening from a cohort participating in a Canadian randomized controlled cervical cancer screening trial.
    BMC Public Health 10/2014; 14(1):1060. DOI:10.1186/1471-2458-14-1060 · 2.32 Impact Factor
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    ABSTRACT: Hepatitis C virus (HCV) currently infects approximately 250,000 individuals in Canada and causes more years of life lost than any other infectious disease in the country. In August 2011, new therapies were approved by Health Canada that have achieved higher response rates among those treated, but are poorly tolerated. By 2014⁄2015, short-course, well-tolerated treatments with cure rates >95% will be available. However, treatment uptake is poor due to structural, financial, geographical, cultural and social barriers. As such, 'Barriers to access to HCV care in Canada' is a crucial topic that must be addressed to decrease HCV disease burden and potentially eliminate HCV in Canada. Understanding how to better care for HCV-infected individuals requires integration across multiple disciplines including researchers, clinical services and policy makers to address the major populations affected by HCV including people who inject drugs, baby boomers, immigrants and Aboriginal and⁄or First Nations people. In 2012, the National CIHR Research Training Program in Hepatitis C organized the 1st Canadian Symposium on Hepatitis C Virus (CSHCV) in Montreal, Quebec. The 2nd CSHCV was held in 2013 in Victoria, British Columbia. Both symposia were highly successful, attracting leading international faculty with excellent attendance leading to dialogue and knowledge translation among attendees of diverse backgrounds. The current article summarizes the 3rd CSHCV, held February 2014, in Toronto, Ontario.
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    ABSTRACT: Background & Aims People living with hepatitis C virus (HCV) are at increased risk of all-cause and liver-related mortality, although successful treatment has been shown to reduce this risk. The aim of this study was to provide baseline data on trends in cause-specific mortality, and establish an international surveillance system for evaluating the population level impact of HCV treatments. Methods Population level HCV diagnosis databases from Scotland (1997-2010), Australia (New South Wales [NSW]) (1997-2006), and Canada (British Columbia [BC]) (1997-2003) were linked to corresponding death registries using record linkage. For each region, age-adjusted cause-specific mortality rates were calculated, and trends in annual age-adjusted liver-related mortality were plotted. Results Of 105,138 individuals diagnosed with HCV (21,810 in Scotland, 58,484 in NSW, and 24,844 in BC), there were 7,275 deaths (2,572 in Scotland, 2,655 in NSW, and 2,048 in BC). Liver-related deaths accounted for 26% of deaths in Scotland, 21% in NSW, and 22% in BC. Temporal trends in age-adjusted liver related mortality were stable in Scotland (males p=0.4; females p=0.2) and NSW (males p=0.9; females p=0.9), while there was an increase in BC (males p=0.002; females p=0.04). Conclusions The risk of liver-related mortality after a diagnosis of HCV has remained stable or increased over time across three regions with well-established diagnosis databases, highlighting that HCV treatment programmes to-date have had minimal impact on population level HCV-related liver disease. With more effective therapies on the horizon, and greater uptake of treatment anticipated, the potential of future therapeutic strategies to reduce HCV-related mortality is considerable.
    Journal of Hepatology 09/2014; 62(2). DOI:10.1016/j.jhep.2014.09.001 · 10.40 Impact Factor
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    ABSTRACT: Objectives: (1) To describe obstetrical and neonatal outcomes among a cohort of hepatitis C virus (HCV) infected women, comparing HCV RNA positive to HCV RNA negative women; (2) to characterize virologic and hepatic parameters associated with HCV infection during pregnancy; and (3) to describe the rate of HCV vertical transmission. Methods: We prospectively enrolled 145 HCV-positive pregnant women across British Columbia between 2000 and 2003. Participating women were monitored during pregnancy and their infants were followed to assess them for HCV infection. Maternal HCV RNA was assessed close to delivery. Results: Seventy percent of women reported injection drug use as their primary risk factor for HCV acquisition. Observed rates of intrauterine fetal death, preterm delivery, small for gestational age, and low birth weight infants were 3.4%, 17.9%, 11.3%, and 12.5%, respectively, without a significant association with maternal HCV RNA status. The rate of cholestasis was 5.6% in the HCV RNA-positive group (6/108) and 2.8% in the HCV RNA-negative group (1/37) (P = 0.496). Serum alanine aminotransferase levels decreased significantly through pregnancy, and were significantly higher in HCV RNA-positive women than in HCV RNA-negative women after controlling for cholestasis, co-infections, and alcohol consumption. Among the HCV RNA-positive women, the median FIB-4 score was 0.67 (IQR 0.56 to 0.76) in the first trimester, 0.74 (IQR 0.52 to 1.18) in the second trimester, and 0.89 (IQR 0.52 to 1.09) in the third trimester (P = 0.02). The median HCV viral load at delivery was 424 561 IU/mL. The vertical transmission rate was 4.7% in HCV RNA-positive women, with no cases in HCV RNA-negative women. Conclusion: Because of the high rates of poor obstetrical outcomes found in this prospective cohort, population-level screening for HCV in pregnancy should be considered.
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    ABSTRACT: Objectives We compared a 3rd generation (gen) and two 4th gen HIV enzyme immunoassays (EIAs) to pooled nucleic acid testing (PNAT) for the identification of pre- and early seroconversion acute HIV infection (AHI). Study design 9550 specimens from males >18 years from clinics attended by men who have sex with men were tested by Siemens ADVIA Centaur® HIV 1/O/2 (3rd gen) and HIV Combo (4th gen), as well as by Abbott ARCHITECT® HIV Ag/Ab Combo (4th gen). Third gen non-reactive specimens were also tested by Roche COBAS® Ampliprep/COBAS® TaqMan HIV-1 Test v.2 in pools of 24 samples. Sensitivity and specificity of the three EIAs for AHI detection were compared. Results 7348 persons contributed 9435 specimens and had no evidence of HIV infection, 79 (94 specimens) had established HIV infection, 6 (9 specimens) had pre-seroconversion AHI and 9 (12 specimens) had early seroconversion AHI. Pre-seroconversion AHI cases were not detected by 3rd gen EIA, whereas 2/6 (33.3%) were detected by Siemens 4th gen, 4/6 (66.7%) by Abbott 4th gen and 6/6 (100%) by PNAT. All three EIAs and PNAT detected all individuals with early seroconversion AHI. Overall sensitivity/specificity for the EIAs relative to WB or NAT resolved infection status was 93.6%/99.9% for Siemens 3rd gen, 95.7%/99.7% for Siemens 4th gen and 97.9%/99.2% for Abbott 4th gen. Conclusions While both 4th gen EIAs demonstrated improved sensitivity for AHI compared to 3rd gen EIA, PNAT identified more AHI cases than either 4th gen assay. PNAT is likely to remain a useful strategy to identify AHI in high-risk populations.
    Journal of Clinical Virology 09/2014; 61(1). DOI:10.1016/j.jcv.2014.06.024 · 3.47 Impact Factor

Publication Stats

5k Citations
848.10 Total Impact Points

Institutions

  • 2002–2015
    • University of British Columbia - Vancouver
      • • Faculty of Medicine
      • • Department of Pathology and Laboratory Medicine
      • • Department of Anesthesiology, Pharmacology and Therapeutics
      Vancouver, British Columbia, Canada
  • 2001–2015
    • BC Centre for Disease Control
      Vancouver, British Columbia, Canada
  • 2014
    • Centre for Chronic Disease Control
      New Dilli, NCT, India
  • 2006
    • UHN: Toronto General Hospital
      Toronto, Ontario, Canada
  • 2005
    • Vancouver General Hospital
      Vancouver, British Columbia, Canada
  • 2000
    • University of Miami Miller School of Medicine
      Miami, Florida, United States
  • 1999
    • The Princess Margaret Hospital
      Toronto, Ontario, Canada
  • 1993–1999
    • Toronto Western Hospital
      Toronto, Ontario, Canada
  • 1994–1998
    • University of Toronto
      • Department of Laboratory Medicine and Pathobiology
      Toronto, Ontario, Canada