ABSTRACT
Despite the accuracy of confirmatory tests for the diagnosis of human T cell lymphotropic virus (HTLV), inconclusive or false-negative results still occur when diagnosing human T cell lymphotropic virus type 2 (HTLV-2)-positive patients. The goal of this study was to evaluate the sensitivity and accuracy of a confirmatory immunoassay, the Multi-HTLV assay. A total of 246 plasma samples were tested by real-time polymerase chain reaction (qPCR) and used to calculate the sensitivity and typing accuracy of the Multi-HTLV assay. Of the 246 plasma samples, 127 were positive for human T cell lymphotropic virus type 1 (HTLV-1), 112 were positive for HTLV-2, and 7 were positive for both HTLV-1 and HTLV-2. Thereafter, the nonparametric Mann-Whitney U test was used to calculate the concordance between the qPCR test and Multi-HTLV assay in 12 samples with discrepant and inconclusive qPCR results. The Multi-HTLV assay showed high performance in identifying HTLV-1 and HTLV-2 with sensitivities of 97% [95% confidence interval (CI): 0.92-0.98] and 94% (0.87-0.96), respectively. However, due to typing performance (98% for HTLV-1 and 94% for HTLV-2), it had 95% agreement with positive HTLV-1 qPCR results (95% CI: 90.07-97.81) and 86% (78.04-91.01) of HTLV-2 qPCR results were positive. Moreover, this test was able to recognize 80% of indeterminate samples and all HTLV-2 positive samples that showed false-negative qPCR results. Our findings, derived from a substantial number of HTLV-positive samples, underscore the inherent reliability and feasibility of the Multi-HTLV assay, regardless of the molecular testing facilities. Furthermore, the distinctive multiparametric nature of this assay, combined with its straightforward procedural execution, introduces novel perspectives for analyzing specific serological profiles in each patient, as well as the potential for immunological monitoring of disease progression.
Subject(s)
HIV Infections , HTLV-I Infections , HTLV-II Infections , Human T-lymphotropic virus 1 , Humans , Human T-lymphotropic virus 2/genetics , Reproducibility of Results , Blotting, Western , Human T-lymphotropic virus 1/genetics , HTLV-II Infections/diagnosisABSTRACT
ABSTRACT A significant increase in the incidence of cognitive impairment in HIV/AIDS patients has been continuously observed. Consequently, three classification categories of cognitive impairment have been proposed: asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorder (MND), that correspond to the mild and intermediate forms, and HIV-associated dementia (HAD) for the most severe cases. HIV-associated neurocognitive disorders (HAND) is a broad term that encompasses these three categories. Moreover, the application of neuroimaging methods has led to a major breakthrough in understanding of the neurological changes in HIV, providing greater reliability in the exclusion of associated diseases and allowing earlier diagnosis. Therefore, abnormalities and/or specific neuroimaging elements may soon be incorporated into the HAND classification criteria, which will be of great value in the management of these diseases, including in the optimization of high CNS penetration antiretroviral regimens.
ABSTRACT Um aumento expressivo da incidência de alterações cognitivas em pacientes com AIDS/HIV vem ocorrendo, assim três categorias de acometimento cognitivo foram propostas: comprometimento cognitivo assintomático (ANI) e alteração cognitiva leve/moderada (MND) que correspondem às formas leves e intermediárias; e demência associada ao HIV (HAD), a forma mais grave. O termo HIV-associated neurocognitive disorders (HAND) é uma denominação genérica que engloba as três categorias de acometimento. A aplicação de métodos de neuroimagem agregou grande avanço no entendimento das alterações neurológicas do HIV, promovendo maior confiabilidade na exclusão de patologias associadas e diagnóstico mais precoce. Diante disso, as alterações ou características específicas de neuroimagem podem ser em breve incorporadas aos critérios de classificação da HAND, o que será de grande valor no seu manejo, inclusive no auxílio para a otimização de esquemas antirretrovirais de alta penetração no SNC.
Subject(s)
Humans , AIDS Dementia Complex , Cognition Disorders/diagnostic imagingABSTRACT
A significant increase in the incidence of cognitive impairment in HIV/AIDS patients has been continuously observed. Consequently, three classification categories of cognitive impairment have been proposed: asymptomatic neurocognitive impairment (ANI) and mild neurocognitive disorder (MND), that correspond to the mild and intermediate forms, and HIV-associated dementia (HAD) for the most severe cases. HIV-associated neurocognitive disorders (HAND) is a broad term that encompasses these three categories. Moreover, the application of neuroimaging methods has led to a major breakthrough in understanding of the neurological changes in HIV, providing greater reliability in the exclusion of associated diseases and allowing earlier diagnosis. Therefore, abnormalities and/or specific neuroimaging elements may soon be incorporated into the HAND classification criteria, which will be of great value in the management of these diseases, including in the optimization of high CNS penetration antiretroviral regimens.
Um aumento expressivo da incidência de alterações cognitivas em pacientes com AIDS/HIV vem ocorrendo, assim três categorias de acometimento cognitivo foram propostas: comprometimento cognitivo assintomático (ANI) e alteração cognitiva leve/moderada (MND) que correspondem às formas leves e intermediárias; e demência associada ao HIV (HAD), a forma mais grave. O termo HIV-associated neurocognitive disorders (HAND) é uma denominação genérica que engloba as três categorias de acometimento. A aplicação de métodos de neuroimagem agregou grande avanço no entendimento das alterações neurológicas do HIV, promovendo maior confiabilidade na exclusão de patologias associadas e diagnóstico mais precoce. Diante disso, as alterações ou características específicas de neuroimagem podem ser em breve incorporadas aos critérios de classificação da HAND, o que será de grande valor no seu manejo, inclusive no auxílio para a otimização de esquemas antirretrovirais de alta penetração no SNC.
