Estimation of the Incidence and Molecular Characterization of I-IIV Among Adults Visiting a Voluntary Counseling and Testing Centers at Khartoum State

Abstract

Abstract Detecting newly HIV-infected people has gained much attention recently for extending the usefulness of HIV testing and surveillance in providing information about HIV incidence, monitoring transmission of uncommon subtypes or drug resistance, and examining possible clinical implications for infected individuals. Measuring HIV incidence has proved challenging over the years. A number of serological HIV assays have been proposed, and among these, the BED Capture Enzyme Immunoassay (CEIA) and avidity EIA test are widely used. Although the assays perform well among known seroconverting panels, they has been shown to classifir some long term infected patients as being recently infected. The main aim of this study was to estimate the incidence of HIV among adults aged (l5- 25) years visiting voluntary counseling and testing centers at Khartoum State. - ‘ Individuals were enrolled from Khartoum Voluntary Counseling and Testing (VCT) centers. Initial HIV screening was done based on current national Rapid HIV screening algorithm. Based on the WHO criteria, those who were identified as HIV -positive were classified as recently infected if< 25years of age. Moreover the HIV-positive specimens were subjected to confirmatory test by 4TH gen Elisa and other confumatory test called determine combo and I~HV-positive specimens were subjected to HIV-1 BED incidence assay and lag Avidity test and finally the positive specimens were subjected to PCR. The first test was done using Determine HIV 1/2 as a screening test and followed by a second test (unigold) as confinnatory test and concluded with a third test colloidal as tiebreaker. Of all the screened samples, (n=985) were confirmed positive by the national algorithm of Sudan. Among those confirmed HIV positive (376) samples were positive by the set algorithm rmder the criteria of selection (15- 25) years of age. ~ All samples under the criteria (376) obtained from the Rapid test algorithm were verified using conventional EIA (Biorex P4“ gen). All samples tested by EIA were positive . This was further confinned using the Determine combo test and also all the samples were positive. , The serology-based detection of recent IHV infection (RHI) was confirmed HIV-seropositiveresults. All test specimens are initially run singly on the Awarem BEDTM and there were 106 specimens with ODn< 1.2 and considered as recent and were tested again in triplicate to confirm, their ODn values and out of 106 there were 85 specimens their ODn< 0.8 and consider as recent. All the samples their ODn< 0.8 on the IgG-capture BED-EIA incidence assay were initially run singly by LAg-Avidity EIA and out of 85 specimens there were 85 specimens their ODn< 2.0 and considered as low avidity and retested again in triplicate to confirm, their ODn values and out of 85 specimens there were 84 specimens their ODn< 1.0 and consider as recent . So the HIV incidence using the IgG-capture BED-EIA incidence assay and avidity EIA test was 22.3 %,( 84/376). The recent infection was comparable between male and female, the study found the recent infection among male was 9.3% (35/376) and among female was 13.0% (49/376), giving and estimated incidence of 3.4% per year. In the present work, an HIV-1 molecular epidemiological study conducted to disclose new trends in recently-infected individuals of Khartoum state. By analyzing the HIV-1 genes to describe the distribution characteristic of HIV- 1 subtypes. Study found that the subtype D was the most common one which predominated in Sudan. Study found that women became HIV-infected more frequently, and at an earlier age than the male counterparts like study done in Uganda, observed that new HIV infections were highest in young women. Also‘ there was similar study in Ethiopia using the same technique BED immunoassay and the same subject have been observed in a population similar to those visiting this facility reported an estimated HIV incidence of 2.36 %.( Wolday D et al, (2007).In another study in Kenya for estimating HIV-1 incidence in adults visiting Kenyatta National Hospital VCT centre in Nairobi was estimated using the same immunoassay, for detecting recent ‘infections, reported an estimated HIV incidence of 1.3%. Conclusions. The HIV incidence estimation reflects the underlying transmission dynamics that are currently at work in Sudan. The findings suggest that the current prevention needs more efforts, particularly among young women and men. '