Modification of rapid human immunodeficiency virus (HIV) antibody assay protocols for detecting recent HIV seroconversion

Assay protocols of three rapid human immunodeficiency virus (HIV) assays, OraQuick-1/2, SeroStrip-1/2, and Determine-1/2, were modified to detect recent HIV seroconversion using a higher dilution of serum specimens. Optimal predilution of specimens resulted in negative test results during early periods of seroconversion (about 6 months), when antibody levels were low. A total of 269 seropositive specimens from routine HIV type 1 testing and from commercial sources (low-titer and seroconversion panels) were tested, and results were recorded as negative (score = 0) or positive using intensity scores from 0.5 (weak positive) to 4 (strongly positive). The same specimens were previously tested by a less sensitive (LS) enzyme immunoassay (EIA), Abbott 3A11-LS, and were classified as recent or long-term infections based on the standardized optical density (SOD) cutoff of 0.75. Overall concordance of > 94% was observed between 3A11-LS and modified rapid tests. (RT-LSs) for detecting and distinguishing recent HIV seroconversion from long-term HIV infection (kappa statistics = 0.894 to 0.901). Moreover, intensity scores on RT-LSs correlated well with median 3A11-LS SOD values (R-2 > 0.98). Our results indicate that rapid HIV tests can be modified to detect recent seroconversion with results comparable to those from less sensitive EIA.