Program Schedule

1427
High specificity of OraQuick rapid HIV-1/2 antibody testing during dengue infection

Session: Poster Abstract Session: Diagnostic Microbiology: Viruses/Fungal/AFB/Parasitic
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • oraquik IDweek 2014 poster.pdf (1.9 MB)
  • Background: OraQuick® is a rapid test with high specificity demonstrated in non-dengue endemic settings. However reports of false positive OraQuick® results in the context of dengue infection suggest poor specificity in settings where dengue and HIV co-exist, home to 2.5 billion people. We performed a cross-sectional study across three Singapore hospitals to assess the specificity of OraQuick® for HIV-1/2 antibody detection in patients with dengue infection. 

    Methods: Adult participants meeting WHO 2009 criteria for probable dengue (fever >37.5°C plus two other clinical or haematological criteria) were identified at hospital outpatient clinics from April 2012-July 2013.  Eligible participants were asked to give informed consent to complete a questionnaire on HIV risk factors as well as HIV-1/2 antibody testing by OraQuick® and HIV-1 RNA testing by PCR. Other laboratory data were collected from electronic health records contemporaneously. Dengue testing was by Dengue Duo NS1Ag+Ab Combo kits. Confirmed dengue was defined as NS1-positive and probable dengue as IgM-positive. 

    Results: Of 152 eligible patients, 82 consented to inclusion in the study. Fifty-two of these had dengue; 43 confirmed and 9 probable cases. The mean age was 38.6 years and 38 (73%) were male. Forty-five (86.5%) were Chinese and three were Indian and Malay (5.8% each).  The mean duration of fever at presentation was 5.8 days (range 1 to 14). Thrombocytopenia (23/51, 54.9%), leucopenia (49/51, 96.1%) and transaminitis (16/20, 80%)were common. Thirty-three had been sexually active in the last month, all with opposite sex partners, and eleven without a condom. All patients with dengue had a negative OraQuick® result corresponding to a specificity of 100%. HIV-1 RNA was not detected by PCR in any of the specimens. OraQuick® test kits were a mean 656 days from their expiry date at the time of use (range 477 to 764 days, IQR 603 to 728 days). 

    Conclusion: OraQuick® has high specificity in the context of dengue infection. It can be used to exclude HIV-associated illness as a cause of fever in dengue endemic settings. It should be noted that there are insufficient data in this study to assess the sensitivity of OraQuick® for acute HIV.

    Ayesha Verrall, MBChB, MBHL, DTMH, FRACP, Preventive & Social Medicine, University of Otago, Dunedin, New Zealand, David Lye, MBBS, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore, MJ Khoo, Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, Singapore, Singapore, Singapore, ESC Koay, Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, YS Leo, Tan Tock Seng Hospital, Singapore, Singapore, Dale Fisher, National University Hospital, Singapore, Singapore and Sophia Archuleta, MD, Division of Infectious Diseases, University Medicine Cluster, National University Hospital Singapore, Singapore, Singapore

    Disclosures:

    A. Verrall, Pathway Biomed: Oraquick distributor donated Oraquick kits for this study, Oraquick distributor donated Oraquick kits for this study and Research support

    D. Lye, None

    M. Khoo, None

    E. Koay, None

    Y. Leo, None

    D. Fisher, None

    S. Archuleta, Pathway Biomed: Oraquick distributor donated Oraquick kits for this study, Oraquick kits were gifted to the study team

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