Performance of the Xpert HIV-1 Viral Load Assay: a Systematic Review and Meta-analysis - PubMed (original) (raw)

Meta-Analysis

. 2018 Mar 26;56(4):e01673-17.

doi: 10.1128/JCM.01673-17. Print 2018 Apr.

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Meta-Analysis

Performance of the Xpert HIV-1 Viral Load Assay: a Systematic Review and Meta-analysis

Madlen Nash et al. J Clin Microbiol. 2018.

Abstract

Viral load (VL) is the preferred treatment-monitoring approach for HIV-positive patients. However, more rapid, near-patient, and low-complexity assays are needed to scale up VL testing. The Xpert HIV-1 VL assay (Cepheid, Sunnyvale, CA) is a new, automated molecular test, and it can leverage the GeneXpert systems that are being used widely for tuberculosis diagnosis. We systematically reviewed the evidence on the performance of this new tool in comparison to established reference standards. A total of 12 articles (13 studies) in which HIV patient VLs were compared between Xpert HIV VL assay and a reference standard VL assay were identified. Study quality was generally high, but substantial variability was observed in the number and type of agreement measures reported. Correlation coefficients between Xpert and reference assays were high, with a pooled Pearson correlation (n = 8) of 0.94 (95% confidence interval [CI], 0.89, 0.97) and Spearman correlation (n = 3) of 0.96 (95% CI, 0.86, 0.99). Bland-Altman metrics (n = 11) all were within 0.35 log copies/ml of perfect agreement. Overall, Xpert HIV-1 VL performed well compared to current reference tests. The minimal training and infrastructure requirements for the Xpert HIV-1 VL assay make it attractive for use in resource-constrained settings, where point-of-care VL testing is most needed.

Keywords: HIV; Xpert HIV-1; accuracy; diagnosis; viral load.

Copyright © 2018 Nash et al.

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Figures

FIG 1

FIG 1

PRISMA flow chart.

FIG 2

FIG 2

Forest plot for Pearson and Spearman correlation coefficients from comparison of VL values by Xpert and a reference test for VL.

FIG 3

FIG 3

Forest plot for Bland-Altman (BA) correlation coefficients from comparison of VL values by Xpert and a reference test for VL.

References

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    1. World Health Organization. 2016. Global tuberculosis report. World Health Organization, Geneva, Switzerland.

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