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p24 revisited: A landscape review of antigen detection for early HIV diagnosis

Gray, ER; Bain, R; Varsaneux, O; Peeling, RW; Stevens, MM; Mckendry, RA; (2018) p24 revisited: A landscape review of antigen detection for early HIV diagnosis. AIDS , 32 (15) pp. 2089-2102. 10.1097/QAD.0000000000001982. Green open access

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Abstract

Despite major advances in HIV testing, early detection of infection at the point of care (PoC) remains a key challenge. While rapid antibody PoC and laboratory-based nucleic acid amplification tests dominate the diagnostics market, the viral capsid protein p24 is recognized as an alternative early virological biomarker of infection. However, the detection of ultra-low levels of p24 at the PoC has proven challenging. Here we review the landscape of p24-diagnostics to identify knowledge gaps and barriers and help shape future research agendas. 574 research papers to May 2018 that propose or evaluate diagnostic assays for p24 were identified and reviewed. We give a brief history of diagnostic development, and the utility of p24 as a biomarker in different populations such as infants, the newly infected, those on pre-exposure prophylaxis and self-testers. We review the performance of commercial p24 assays and consider elements such as immune complex disruption, resource-poor settings, prevalence, and assay antibodies. Emerging and ultrasensitive assays are reviewed and show a number of promising approaches but further translation has been limited. We summarize studies on the health economic benefits of using antigen testing. Finally, we speculate on the future uses of high performance p24 assays, particularly if available in self-test format.

Type: Article
Title: p24 revisited: A landscape review of antigen detection for early HIV diagnosis
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAD.0000000000001982
Publisher version: http://dx.doi.org/10.1097/QAD.0000000000001982
Language: English
Additional information: This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0.
Keywords: biomarker; capsid; diagnostic tests; early detection; HIV; point-of-care
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences > London Centre for Nanotechnology
URI: http://discovery.ucl.ac.uk/id/eprint/10054886
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