Performance of Cepheid Xpert HIV-1 viral load plasma assay to accurately detect treatment failure

Jilian A. Sacks, Youyi Fong, Mercedes Perez Gonzalez, Mauro Andreotti, Shrikala Baliga, Nigel Garrett, Jeanne Jordan, Etienne Karita, Smita Kulkarni, Orna Mor, Fausta Mosha, Zibusiso Ndlovu, Jean Christophe Plantier, Shanmugam Saravanan, Lesley Scott, Trevor Peter, Meg Doherty, Lara Vojnov

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)


Background: Coverage of viral load testing remains low with only half of the patients in need having adequate access. Alternative technologies to high throughput centralized machines can be used to support viral load scale-up; however, clinical performance data are lacking. We conducted a meta-analysis comparing the Cepheid Xpert HIV-1 viral load plasma assay to traditional laboratory-based technologies. Methods: Cepheid Xpert HIV-1 and comparator laboratory technology plasma viral load results were provided from 13 of the 19 eligible studies, which accounted for a total of 3790 paired data points. We used random effects models to determine the accuracy and misclassification at various treatment failure thresholds (detectable, 200, 400, 500, 600, 800 and 1000copies/ml). Results: Thirty percent of viral load test results were undetectable, while 45% were between detectable and 10000copies/ml and the remaining 25% were above 10000copies/ml. The median Xpert viral load was 119copies/ml and the median comparator viral load was 157copies/ml, while the log10 bias was 0.04 (0.02-0.07). The sensitivity and specificity to detect treatment failure were above 95% at all treatment failure thresholds, except for detectable, at which the sensitivity was 93.33% (95% confidence interval: 88.2-96.3) and specificity was 80.56% (95% CI: 64.6-90.4). Conclusion: The Cepheid Xpert HIV-1 viral load plasma assay results were highly comparable to laboratory-based technologies with limited bias and high sensitivity and specificity to detect treatment failure. Alternative specimen types and technologies that enable decentralized testing services can be considered to expand access to viral load.

Original languageEnglish
Pages (from-to)1881-1889
Number of pages9
Issue number12
Publication statusPublished - 01-10-2019

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases


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