Curaçao Cohort Study - BED-study
Student Project Protocol
Project code:
Duration: 4-6 months
Student:
Daily coach Netherlands:
Daily coach Curaçao: drs H.S. Hermanides - gonnekehermanides@gmail.com
Supervisor Curaçao: Prof dr A.J. Duits
Senior tutor:
Background
To date, the most important measure to monitor the HIV epidemic has been the reporting of newly diagnosed infections. However the major limitation of this approach is that it does not give an accurate picture of the evolving status of the epidemic as it comprises both patients with recent infection and patients already infected for several years (1). Knowledge about trends and current patterns of HIV-1 infections is essential for planning and evaluating prevention efforts and for resource allocations (2).
Trends in HIV-1 transmission can be discerned either through finding and reporting of new cases or through the traditional method of following longitudinal cohorts. However, these approaches are time consuming, logistically difficult, expensive and may be subject to participation bias (3). Natural history of HIV type 1 has features that evolve and could be used to distinguish between recent and long term infection (4-10). Early infection comprises the period from exposure to seroconversion, during which HIV-1 antigen or nucleic acid may be detected, and the period after seroconversion, during which the antibody response evolves and matures.
The development of laboratory assays that differentiate recent versus longstanding HIV infections now makes it possible to directly measure HIV incidence (11-13).
The BED assay uses antibodies to detect all HIV subtypes, and it detects levels of anti-HIV IgG relative to total IgG. It is based on the observation that the ratio of anti-HIV IgG to total IgG increases with time shortly after HIV infection (2). The combination of diagnostic testing (confirmed HIV antibody-positive) followed by recent infection testing is known as the serologic testing algorithm for recent HIV seroconversion (STARHS) (11). Literature has been published on the implementation of STARHS methods in the United States (2), France, Germany and Portugal (14-16). The value of STARHS method for the Caribbean setting has never been assessed.
Study objectives
Primary Objective: To assess the evolving status of the HIV epidemic in a small Caribbean setting by conducting research on the status of infection by conducting BED ESSAY techniques in newly diagnosed HIV infections combed with assessment on testing patterns in Curaçao.
Secondary Objectives: To assess the validity of the STARHS method in a Caribbean setting.
Institutions
HIV Monitoring Foundation, Academic Medical Center, Amsterdam, the Netherlands. GGD Curaçao, Red Cross Blood Bank Foundation, Willemstad, Curaçao.
Study Location
GGD Curaçao and Red Cross Foundation Blood Bank, Willemstad, Curaçao.
Study methods
Remnant diagnostic specimens from patients 13 years or older and newly diagnosed with HIV during 2008 and 2009 in the population of Curaçao will be tested with BED HIV-1 capture enzyme immunoassay to classify infections as recent or non-recent. Information of HIV cases reported to the Ministry of Health, through its National Medical and Public Health Service, during 2008 and 2009 will be used to estimate the status of the HIV epidemic by using a statistical approach with adjustment for testing frequency.
Testing policies will be assessed by having interviews with referring physicians.
Study population
HIV infected adult patients on Curaçao and health care providers working on Curaçao.
Student Project Goals
Primary student project goal: The student will characterise the status of the HIV epidemic by assessing the status of HIV infection in the newly HIV infected population in Curaçao over a defined period of time. In that same period, the student will conduct research on testing patterns by taking questionnaires on referring health care providers and institutions. Available epidemiologic data will be used to obtain a denominator.
Secondary student project goals: To assist the principal investigator in the inclusion procedure and to assist in the preparation of the needed study materials.
Literature
1. Barin F, Nardone A. Monitoring HIV epidemiology using assays for recent infection: where are we? Euro Surveill 2008;13(36).
2. Hall HI, Song R, Rhodes P, Prejean J, An Q, Lee LM, et al. Estimation of HIV incidence in the United States. Jama 2008;300(5):520-9.
3. McDougal JS, Pilcher CD, Parekh BS, Gershy-Damet G, Branson BM, Marsh K, et al. Surveillance for HIV-1 incidence using tests for recent infection in resource-constrained countries. Aids 2005;19 Suppl 2:S25-30.
4. Cole KS, Rowles JL, Jagerski BA, Murphey-Corb M, Unangst T, Clements JE, et al. Evolution of envelope-specific antibody responses in monkeys experimentally infected or immunized with simian immunodeficiency virus and its association with the development of protective immunity. J Virol 1997;71(7):5069-79.
5. Cole KS, Murphey-Corb M, Narayan O, Joag SV, Shaw GM, Montelaro RC. Common themes of antibody maturation to simian immunodeficiency virus, simian-human immunodeficiency virus, and human immunodeficiency virus type 1 infections. J Virol 1998;72(10):7852-9.
6. Cole KS, Paliotti MJ, Murphey-Corb M, Montelaro RC. Maturation of envelope-specific antibody responses to linear determinants in monkeys inoculated with attenuated SIV. J Med Primatol 2000;29(3-4):220-30.
7. McDougal JS, Kennedy MS, Nicholson JK, Spira TJ, Jaffe HW, Kaplan JE, et al. Antibody response to human immunodeficiency virus in homosexual men. Relation of antibody specificity, titer, and isotype to clinical status, severity of immunodeficiency, and disease progression. J Clin Invest 1987;80(2):316-24.
8. Parekh BS, Pau CP, Kennedy MS, Dobbs TL, McDougal JS. Assessment of antibody assays for identifying and distinguishing recent from long-term HIV type 1 infection. AIDS Res Hum Retroviruses 2001;17(2):137-46.
9. Radkowski M, Laskus T, Goch A, Slusarczyk J. Affinity of anti-GP41 antibody in patients infected with human immunodeficiency virus type 1. Eur J Clin Invest 1993;23(8):455-8.
10. Thomas HI, Wilson S, O'Toole CM, Lister CM, Saeed AM, Watkins RP, et al. Differential maturation of avidity of IgG antibodies to gp41, p24 and p17 following infection with HIV-1. Clin Exp Immunol 1996;103(2):185-91.
11. Janssen RS, Satten GA, Stramer SL, Rawal BD, O'Brien TR, Weiblen BJ, et al. New testing strategy to detect early HIV-1 infection for use in incidence estimates and for clinical and prevention purposes. Jama 1998;280(1):42-8.
12. Parekh BS, Kennedy MS, Dobbs T, Pau CP, Byers R, Green T, et al. Quantitative detection of increasing HIV type 1 antibodies after seroconversion: a simple assay for detecting recent HIV infection and estimating incidence. AIDS Res Hum Retroviruses 2002;18(4):295-307.
13. Brookmeyer R, Quinn TC. Estimation of current human immunodeficiency virus incidence rates from a cross-sectional survey using early diagnostic tests. Am J Epidemiol 1995;141(2):166-72.
14. Cortes Martins H PT. Setting for identifying recent HIV infections: the Portugese experience. Eurosurveillance.
15. EuroHIV. HIV/ AIDS Surveillance in Europe. End-year report 2006. Saint-Maurice: Institut de veille sanitaire. 2007;75.
16. Semaille C, Cazein F, Pillonel J, Lot F, Le Vu S, Pinget R, et al. Four years of surveillance of recent HIV infections at country level, France, mid 2003 - 2006: experience and perspectives. Euro Surveill 2008;13(36).
