Improved HIV-1 incidence estimates using the BED capture enzyme immunoassay

Objective: To validate the BED capture enzyme immunoassay for HIV-1 subtypeCand to derive adjustments facilitating estimation of HIV-1 incidence from cross-sectional surveys. Design: Laboratory analysis of archived plasma samples collected in Zimbabwe. Methods: Serial plasma samples from 85 women who seroconverted to HIV-1 during the postpartum year were assayed by BED and used to estimate the window period between seroconversion and the attainment of a specified BED absorbance. HIV-1 incidences for the year prior to recruitment and for the postpartum year were calculated by applying the BED technique to HIV-1-positive samples collected at baseline and at 12 months. Results: The mean window for an absorbance cut-off of 0.8 was 187 days. Among women who were HIV-1 positive at baseline and retested at 12 months, aproportion (E) 5.2% (142/2749) had a BED absorbance < 0.8 at 12 months and were falsely identified as recent seroconverters. Consequently, the estimated BED annual incidence at 12 months postpartum (7.6%) was 2.2 times the contemporary prospective estimate. BED incidence adjusted for e was 3.5% [95% confidence interval (Cl), 2.6-4.5], close to the 3.4% estimated prospectively. Adjusted BED incidence at baseline was 6.0% (95% Cl, 5.2-6.9) and, like the prospective estimates, declined with maternal age. Unadjusted BED incidence estimates were largely independent of age; the pooled estimate was 58% higher than adjusted incidence. Conclusion: The BED method can be used in an African setting, but further estimates of e and of the window period are required, using large samples in a variety of circumstances, before its general utility can be gauged. (c) 2008 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins