Cobas Ampliprep/Cobas Taqman Hiv-1 Test: For in Vitro Diagnostic Use
Cobas Ampliprep/Cobas Taqman Hiv-1 Test: For in Vitro Diagnostic Use
Cobas Ampliprep/Cobas Taqman Hiv-1 Test: For in Vitro Diagnostic Use
COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test HIMCAP 48 Tests P/N: 03542998 190
COBAS® AmpliPrep/COBAS® TaqMan® PG WR 5.1 Liters P/N: 03587797 190
Wash Reagent
INTENDED USE
The COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test is an in vitro nucleic acid amplification test for
the quantitation of Human Immunodeficiency Virus Type 1 (HIV-1) RNA in human plasma using the
COBAS® AmpliPrep Instrument for automated specimen processing and COBAS® TaqMan® Analyzer or
COBAS® TaqMan® 48 Analyzer for automated amplification and detection.
This test is intended for use in conjunction with clinical presentation and other laboratory markers of dis
ease progress for the clinical management of HIV-1 infected patients. The Test can be used to assess patient
prognosis by measuring the baseline HIV-1 RNA level or to monitor the effects of antiretroviral therapy by
measuring changes in EDTA plasma HIV-1 RNA levels during the course of antiretroviral treatment.
The COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test is not intended for use as a screening test for the
presence of HIV-1 in blood or blood products or as a diagnostic test to confirm the presence of HIV-1
infection.
The test can quantitate HIV-1 RNA over the range of 48 - 10,000,000 copies/mL. One copy of HIV-1 RNA
is equivalent to 1.7 ± 0.1 International Units (IU) based on the WHO 1st International Standard for HIV-1
RNA for Nucleic Acid-Based Techniques (NAT) (NIBSC 97/656).
SUMMARY AND EXPLANATION OF THE TEST
Human Immunodeficiency Virus (HIV) is the etiologic agent of Acquired Immunodeficiency Syndrome
(AIDS)1-3. HIV infection can be transmitted by sexual contact, exposure to infected blood or blood prod
ucts, or by an infected mother to the fetus4. Within three to six weeks of exposure to HIV, infected individ
uals generally develop a brief, acute syndrome characterized by flu-like symptoms and associated with high
levels of viremia in the peripheral blood5-8. In most infected individuals this is followed by an HIV-specific
immune response and a decline of plasma viremia, usually within four to six weeks of the onset of symp
toms9,10. After seroconversion, infected individuals typically enter a clinically stable, asymptomatic phase
that can last for years11-13. The asymptomatic period is characterized by persistent, low level plasma
viremia14 and a gradual depletion of CD4+ T lymphocytes, leading to severe immunodeficiency, multiple
opportunistic infections, malignancies and death15. Although virus levels in the peripheral blood are rela
tively low during the asymptomatic phase of the infection, virus replication and clearance appear to be
dynamic processes in which high rates of virus production and infection of CD4+ cells are balanced by
equally high rates of virus clearance, death of infected cells and replenishment of CD4+ cells, resulting in
relatively stable levels of both plasma viremia and CD4+ cells16-18.
Quantitative measurements of HIV viremia in the peripheral blood have shown that higher virus levels may
be correlated with increased risk of clinical progression of HIV disease, and that reductions in plasma virus
levels may be associated with decreased risk of clinical progression19-21. Virus levels in the peripheral blood
can be quantitated by measurement of the HIV p24 antigen in serum, by quantitative culture of HIV from
plasma, or by direct measurement of viral RNA in plasma using nucleic acid amplification or signal ampli
fication technologies22-26.
p24 antigen is the principal core protein of HIV and is found in serum either free or bound by anti-p24 anti
body. Free p24 antigen can be measured with commercially available enzyme immunoassays (EIA), although
the usefulness of p24 antigen as a marker of viral load is limited since the antigen is detectable in only 20%
of asymptomatic patients and 40-50% of symptomatic patients. Procedures to dissociate antigen-antibody
complexes improve the sensitivity of the p24 antigen tests, but the viral protein remains undetectable in
most asymptomatic patients22.
Infectious HIV in plasma can be cultured by inoculation into activated peripheral blood mononuclear cells
(PBMC) from normal donors. Quantitation is achieved by inoculating PBMC with serial dilutions of the
plasma specimen. Quantitative culture has limited utility for monitoring virus levels in infected individuals
since only a small fraction of virus particles is infectious in vitro. Infectious virus is often undetectable in
asymptomatic individuals22.
HIV RNA in plasma can be quantitated by nucleic acid amplification technologies, such as the Polymerase
Chain Reaction (PCR)27-29. The COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test uses PCR technology
to achieve high sensitivity and dynamic range for the quantitative detection of HIV-1 RNA in EDTA anti
coagulated plasma.
9.00
8.00
7.00
6.00
Normalized Fluorescence
5.00
4.00
2.00
0.00
-1.00
0 10 20 30 40 50 60
Cycle Number
Figure 2 shows the Quantitation Standard growth curves for specimens from a viral dilution series that
spans a 5-log10 range. The amount of Quantitation Standard added to each specimen is constant for
each reaction. The Ct value of the Quantitation Standard is similar regardless of the target viral titer.
Figure 2
Quantitation Standard Growth Curves for Specimens from a Viral Dilution Series
35.00
25.00
Normalized Fluorescence
20.00
15.00
10.00
0.00
-5.00
0 10 20 30 40 50 60
Cycle Number
Figure 3 provides an example of how the fluorescence values at every cycle are normalized for each
growth curve. The critical threshold value (Ct) is calculated where the fluorescence signal crosses the
Assigned Fluorescence Level.
Figure 3
0.9
0.6
0.5
0.4
0.3
0.2
0.1
-0.1
-0.2
19 20 21 22 23 24 25 26 27 28 29
Cycle Number
REAGENTS
COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test HIMCAP
48 Tests
(P/N: 03542998 190)
HIV-1 CS1 1 x 48 Tests
(HIV-1 Magnetic Glass Particles Reagent Cassette) 1 x 7.0 mL
Magnetic glass particles
93% Isopropanol
Xi 93% (w/w) Isopropanol
+ Irritant
F 93% (w/w) Isopropanol
h
Highly
Flammable
HIV-1 CS2 1 x 48 Tests
(HIV-1 Lysis Reagent Cassette) 1 x 78 mL
Sodium citrate dihydrate
Harmful
HIV-1 CS3 1 x 48 Tests
HIV-1 Multi-Reagent Cassette containing:
Pase 1 x 3.8 mL
(Proteinase Solution)
Tris buffer
< 0.05% EDTA
Calcium chloride
Calcium acetate
≤ 7.8% Proteinase
Glycerol
Xn ≤ 7.8% (w/w) Proteinase
+
Harmful
EB 1 x 7.0 mL
(Elution Buffer)
Tris-base buffer
0.2% Methylparaben
HIV-1 CS4 1 x 48 Tests
HIV-1 Test-Specific Reagent Cassette containing:
HIV-1 QS 1 x 3.6 mL
(HIV-1 Quantitation Standard)
Tris-HCl buffer
EDTA
< 0.005% Poly rA RNA (synthetic)
< 0.001% Armored HIV-1 RNA construct containing HIV-1 primer
binding sequences and a unique probe binding region
(non-infectious RNA in MS2 bacteriophage)
0.05% Sodium azide
6
HIV-1 MMX 1 x 2.5 mL
(HIV-1 Master Mix)
Tricine buffer
Potassium acetate
Potassium hydroxide
20% Dimethylsulfoxide
Glycerol
region of HIV-1
and HBsAg; HIV-1 RNA, HCV RNA and HBV DNA not detectable
by PCR methods
HIV-1 RNA, HCV RNA and HBV DNA not detectable by PCR methods
HIV-1 RNA, HCV RNA and HBV DNA not detectable by PCR methods
8
B. Store HIV-1 CS1, HIV-1 CS2, HIV-1 CS3 and HIV-1 CS4 at 2-8ºC. Unused, these reagents are
stable until the expiration date indicated. Once used, these reagents are stable for 28 days at
2-8°C or until the expiration date, whichever comes first. HIV-1 CS1, HIV-1 CS2, HIV-1 CS3 and
HIV-1 CS4 can be used for a maximum of 4 instrument cycles, up to a maximum of 64 hours cumu
lative on board the COBAS® AmpliPrep Instrument. Reagents must be stored at 2-8°C between
instrument cycles.
C. S
tore HIV-1 H(+)C, HIV-1 L(+)C and CTM (–) C at 2-8ºC. The controls are stable until the expira
tion date indicated. Once opened, any unused portion must be discarded.
D. Store Barcode clips [HIV-1 H(+)C Clip, HIV-1 L(+)C Clip and HIV-1 (–) C Clip] at 2-30°C.
E. Store PG WR at 2-30°C. PG WR is stable until the expiration date indicated. Once opened, this
reagent is stable for 28 days at 2-30°C or until the expiration date, whichever comes first.
MATERIALS PROVIDED
A. COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test HIMCAP
(P/N: 03542998 190)
HIV-1 CS1
(HIV-1 Magnetic Glass Particles Reagent Cassette)
HIV-1 CS2
(HIV-1 Lysis Reagent Cassette)
HIV-1 CS3
(HIV-1 Multi-Reagent Cassette)
HIV-1 CS4
(HIV-1 Test-Specific Reagent Cassette)
HIV-1 H(+)C
(HIV-1 High Positive Control)
HIV-1 L(+)C
(HIV-1 Low Positive Control)
CTM (–) C
[COBAS® TaqMan® Negative Control (Human Plasma)]
HIV-1 H(+)C Clip
(HIV-1 High Positive Control Barcode Clip)
HIV-1 L(+)C Clip
(HIV-1 Low Positive Control Barcode Clip)
HIV-1 (–) C Clip
(HIV-1 Negative Control Barcode Clip)
B. COBAS® AmpliPrep/COBAS® TaqMan® Wash Reagent PG WR
(P/N: 03587797 190)
PG WR
(COBAS® AmpliPrep/COBAS® TaqMan® Wash Reagent)
8.00
7.00
6.00
Average Log Titer
5.00
4.00
3.00
2.00
1.00
0 hr 2 hrs - 28±2˚C 6 hrs - 28±2˚C 6 hrs - 2-8˚C
Test Condition
10
B. Specimen Transport
Transportation of whole blood or plasma must comply with country, federal, state and local regulations for
the transport of etiologic agents39. Whole blood must be transported at 2-25°C and centrifuged within 6
hours of collection. Plasma may be stored at room temperature for up to 1 day, at 2-8°C for up to 5 days
or frozen at -20°C to -80°C for longer storage. Figure 5 shows the stability for HIV-1 in EDTA plasma.
C. Specimen Storage
Plasma specimens may be stored at room temperature for up to 1 day, at 2-8°C for up to 5 days or frozen
at -20°C to -80°C. It is recommended that specimens be stored in 1100-1200 µL aliquots in sterile, 2.0
mL polypropylene screw-cap tubes (such as Sarstedt 72.694.006). Plasma specimens may be frozen and
thawed up to five times without a loss of HIV-1 RNA. Figure 6 shows the data from a freeze/thaw study
(study was performed using COBAS® TaqMan® HIV-1 Test for use with the High Pure System (HPS), P/N:
03501752 190 and 03502295 001).
Figure 5
8.00
7.00
6.00
Average Log Titer
5.00
4.00
3.00
2.00
1.00
0hr 2hrs - 28±2˚C 24hrs - 28±2˚C 24hrs - 2-8˚C 72hrs - 2-8˚C 120hrs - 2-8˚C
Test Condition
Figure 6
8.00
7.00
6.00
Average Log Titer
5.00
4.00
3.00
2.00
1.00
0 1 2 3 4 5
Number of Freeze/Thaw Cycles
11
12
13
Table 1
14
15
16
RESULTS
The COBAS® TaqMan® Analyzer or the COBAS® TaqMan® 48 Analyzer automatically determines the
HIV-1 RNA concentration for the specimens and controls. The HIV-1 RNA concentration is expressed in
copies (cp)/mL. The conversion factor between HIV-1 RNA copies/mL and HIV-1 International Units
(IU)/mL is 0.6 cp/IU, using the WHO 1st International Standard for HIV-1 RNA for Nucleic Acid-Based
Techniques (NAT) (NIBSC 97/656).
AMPLILINK Software:
• Determines the Cycle Threshold value (Ct) for the HIV-1 RNA and the HIV-1 QS RNA.
• Determines the HIV-1 RNA concentration based upon the Ct values for the HIV-1 RNA and
HIV-1 QS RNA and the lot-specific calibration coefficients provided on the cassette barcodes.
• Determines that the calculated cp/mL for HIV-1 L(+)C and HIV-1 H(+)C fall within the assigned ranges.
Batch Validation
Check AMPLILINK software results window or printout for flags and comments to ensure that the
batch is valid.
NOTE: For instructions on printing results and for interpreting flags and comments, please refer
to the following: (a) the AMPLILINK Software Version 3.1.x Series Application Manual for
use with the COBAS® AmpliPrep Instrument, COBAS® TaqMan® Analyzer, and COBAS®
TaqMan® 48 Analyzer or (b) the COBAS® AmpliPrep Instrument Manual for use with the
COBAS® TaqMan® Analyzer or COBAS® TaqMan® 48 Analyzer and the AMPLILINK
Software, Version 3.1.x Series and (c) the COBAS® TaqMan® Analyzer (plus optional
Docking Station) Instrument Manual for use with AMPLILINK Software, Version 3.1.x Series
or (d) the COBAS® TaqMan® 48 Analyzer Instrument Manual for use with AMPLILINK
Software, Version 3.1.x Series.
For control orders, a check is made to determine if the cp/mL value for the control is within its spec
ified range. If the cp/mL value for the control lies outside of its range, a FLAG is generated to show
the control has failed.
The batch is valid if no flags appear for any of the controls [HIV-1 H(+)C, HIV-1 L(+)C, CTM (–) C].
The following results are obtained for a valid batch:
The batch is not valid if any of the following flags appear for the HIV-1 Controls:
Negative Control:
Flag Result Interpretation
An invalid result or a "valid"
__N_NC_INVALID Invalid result that was not negative
for HIV-1 target
17
If the batch is invalid, repeat the entire batch including specimen and control preparation, amplification
and detection.
Interpretation of Results:
For a valid batch, check each individual specimen for flags or comments on the result printout. Interpret
the results as follows:
⇒ A valid batch may include both valid and invalid specimen results depending on whether flags
and/or comments are obtained for the individual specimens.
Specimen results are interpreted as follows:
Titer Result Interpretation
Target Not Detected Ct value for HIV-1 above the limit for the assay or no Ct value for HIV-1
obtained. Report results as "HIV-1 RNA not detected".
< 4.80E+01 cp/mL Calculated cp/mL are below the Limit of Detection of the assay. Report
results as "HIV-1 RNA detected, less than 48 HIV-1 RNA cp/mL".
≥ 4.80E+01 cp/mL and Calculated results greater than or equal to 48 cp/mL and less than or
≤ 1.00E+07 cp/mL equal to 1.00E+07 cp/mL are within the Linear Range of the assay.
> 1.00E+07 cp/mL Calculated cp/mL are above the range of the assay. Report results as
"greater than 1.00E+07 HIV-1 RNA cp/mL". If quantitative results are
desired, the original specimen should be diluted with HIV-1-negative
human EDTA-plasma and the test repeated. Multiply the reported result
by the dilution factor.
NOTE: Specimens above the range of the assay may also produce an Invalid result with a flag
"QS_INVALID". If quantitative results are desired, the original specimen should be diluted
with HIV-1-negative human EDTA-plasma and the test repeated. Multiply the reported
result by the dilution factor.
18
QUALITY CONTROL
One replicate each of the COBAS® TaqMan® Negative Control, the HIV-1 Low Positive Control and the
HIV-1 High Positive Control must be included in each test batch. The batch is valid if no flags appear for any
of the controls [HIV-1 H(+)C, HIV-1 L(+)C and CTM (–) C].
There are no requirements regarding the position of the controls on the sample rack.
Check the batch printout for flags and comments to ensure that the batch is valid. Refer to the following
manuals for detailed information on printing results and interpreting comments: (a) the AMPLILINK Software
Version 3.1.x Series Application Manual for use with the COBAS® AmpliPrep Instrument, COBAS® TaqMan®
Analyzer, and COBAS® TaqMan® 48 Analyzer and either (b) the COBAS® TaqMan® Analyzer (plus optional
Docking Station) Instrument Manual for use with AMPLILINK Software, Version 3.1.x Series or (c) the
COBAS® TaqMan® 48 Analyzer Instrument Manual for use with AMPLILINK Software, Version 3.1.x Series.
Negative Control
The CTM (–) C must yield a "Target Not Detected" result. If the CTM (–) C is flagged as invalid, then the entire
batch is invalid. Repeat the entire process (specimen and control preparation, amplification and detection). If
CTM (–) C is consistently invalid in multiple batches, contact your local Roche office for technical assistance.
Positive Controls
The assigned range for HIV-1 L(+)C and HIV-1 H(+)C is specific for each lot of reagents, and is provided
on the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test reagent cassette barcodes.
The HIV-1 RNA cp/mL for HIV-1 L(+)C and HIV-1 H(+)C should fall within their assigned ranges. If one or both of
the positive controls are flagged as invalid, then the entire batch is invalid. Repeat the entire process (specimen and
control preparation, amplification and detection). If the HIV-1 RNA titer of one or both of the positive controls is con
sistently outside the assigned ranges in multiple batches, contact your local Roche office for technical assistance.
PROCEDURAL PRECAUTIONS
1. As with any test procedure, good laboratory technique is essential to the proper performance of this
assay.
PROCEDURAL LIMITATIONS
1. This test has been validated for use with only human plasma collected in EDTA anticoagulant. Testing
of other specimen types may result in inaccurate results.
2. The performance of the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test has neither been evalu
ated with specimens containing HIV-1 groups O and N, nor with specimens containing HIV-2.
3. Reliable results are dependent on adequate specimen collection, transport, storage and processing
procedures.
4. The presence of AmpErase enzyme in the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Master Mix
reduces the risk of amplicon contamination. However, contamination from HIV-1 positive controls and
clinical specimens can be avoided only by good laboratory practices and careful adherence to the
procedures specified in this Package Insert.
5. Use of this product should be limited to personnel trained in the techniques of PCR.
6. This product can only be used with the COBAS® AmpliPrep Instrument and the COBAS® TaqMan®
Analyzer or COBAS® TaqMan® 48 Analyzer.
19
INTERFERING SUBSTANCES
Elevated levels of triglycerides, bilirubin, albumin, hemoglobin and human DNA in specimens as well as the
presence of autoimmune diseases such as Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis (RA)
and Antinuclear Antibody (ANA) have been shown not to interfere with the quantitation of HIV-1 RNA or impact
the specificity of the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test.
The following drug compounds tested at the Peak Plasma Level (Cmax) and at 3 times the Cmax have been
shown not to interfere with the quantitation of HIV-1 RNA or impact the specificity of the COBAS®
AmpliPrep/COBAS® TaqMan® HIV-1 Test with the exception of Nevirapine, for which absence of interference
has only been shown at the Peak Plasma Level (Cmax):
20
Total Precision for three lots of the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test
21
C. Linear Range
As shown in Figure 7, the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test was found to give a linear
response from 48 HIV-1 RNA cp/mL to 10,000,000 HIV-1 RNA cp/mL applying the accuracy acceptance
criterion of ± 0.3 log10 from the nominal input concentration. The study was performed using one lot of
COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test reagents, with 103 – 105 replicates per level.
Figure 7
8 y = 1.0086x - 0.0555
HIV-1 Test Mean log10 Result
2
7 R = 0.99
6
0
0 1 2 3 4 5 6 7 8
Log 10 Nominal HIV-1 RNA Input Concentration (cp/mL)
D. Inclusivity
Eight subtype categories have been proposed for HIV-1 group M based on nucleotide divergence. These
subtypes are designated with capital alphabetical letters from A through H40.
Similar Subtype Quantitation
The performance of the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test on HIV-1 subtypes was eval
uated by analysis of cell culture stock material of representatives of each HIV-1 group M subtype A
through H. The assignment of nominal concentrations of the cell culture stock solutions was performed
by the COBAS® AmpliPrep/COBAS® AMPLICOR® HIV-1 MONITOR Test, v1.5 assay method (Figure 8).
Based on the determined stock concentrations, the HIV-1 target concentrations of 2.0E+02, 1.9 - 3.3E+04
and 1.0E+05 - 1.0E+06 cp/mL were prepared for each HIV-1 subtype by exact dilution of the cell culture
stock solution in EDTA plasma. Afterwards the concentrations were determined by the COBAS®
AmpliPrep/COBAS® TaqMan® HIV-1 Test in n=7 replicates per level of each subtype using one reagent
lot. Results were compared to the input concentrations as determined by the reference method.
The COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test gave equivalent results for all tested representa
tives of the HIV-1 group M subtypes (see Figure 8). Mean observed log10 concentration results were within
± 0.3 log10 of the respective reference method input concentration.
22
Figure 8
5.5
Mean Log10 Concentration
4.5
3.5
2.5
1.5
A B C D E F G H
23
Table 4
determined with cell-cultured viral stocks of the different HIV-1 subtypes diluted in EDTA plasma
24
F. Analytical Specificity
The analytical specificity of the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test was evaluated by
adding cultured organisms (viruses, bacteria, yeast) or DNA (HTLV-2) at 5E+04 particles/mL input con
centration into HIV-1-negative human EDTA plasma and into HIV-1-positive human EDTA plasma at 1E+04
cp/mL HIV-1 (see Table 5). The cultured organisms added to specimens have been shown not to inter
fere with the quantitation of HIV-1 RNA or impact the specificity of COBAS® AmpliPrep/COBAS®
TaqMan® HIV-1 Test.
Table 5
Virus Bacteria
Adenovirus type 2 Staphylococcus aureus
Cytomegalovirus Propionibacterium acnes
Epstein-Barr Virus
Human Herpes Virus type 6
Herpes simplex virus type 1
Herpes simplex virus type 2
Human T-Cell Lymphotropic virus type 1 Yeast
Human T-Cell Lymphotropic virus type 2 Candida albicans
Influenza A
Hepatitis A virus
Hepatitis B virus
Hepatitis C virus
G. Method Correlation
The performance of the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test was compared to the
COBAS® AmpliPrep/COBAS® AMPLICOR® HIV-1 MONITOR Test, v1.5, to the COBAS® AMPLICOR®
HIV-1 MONITOR Test, v1.5 and to the VERSANT HIV-1 RNA 3.0 Assay (bDNA) by analysis of n=71 undi
luted clinically characterized plasma specimens from HIV-1 infected patients. Specimens were obtained
from Teragenix (Fort Lauderdale, FL, USA). Correlation was determined using the specimens for which
quantitative results were obtained with each method under comparison. Specimens with a concentration
result above the measuring range of the COBAS® AmpliPrep/COBAS® AMPLICOR® HIV-1 MONITOR
Test, v1.5 using the ultrasensitive procedure (PHS) were prediluted to fall into the measuring range of the
PHS. Bivariate linear regression analysis was performed on those specimens that yielded results within
the linear range as shown in Figures 9, 10 and 11. The results obtained with the three methods under
comparison showed high correlation.
Figure 9
7
COBAS® TaqMan® HIV-1 Test conc.)
6 y = 0.9621x + 0.0114
log 10 (COBAS® AmpliPrep/
2
R = 0.9603
5
1
1 2 3 4 5 6 7
25
Figure 10
1
1 2 3 4 5 6 7
® ®
log10 (COBAS AMPLICOR HIV-1 MONITOR Test, v1.5 conc.)
Figure 11
7
COBAS ® TaqMan ® HIV-1 Test conc.)
6 y = 0.960x + 0.292
log 10 (COBAS®AmpliPrep/
2
R = 0.954
5
1
1 2 3 4 5 6 7
log 10 (VERSANT HIV-1 RNA 3.0 Assay)
26
Note: Within assay range results are from 4.80E+1 cp/mL to 1.00E+7 cp/mL inclusive.
Table 7
HIV-1 Negative Panel Member Summary
27
Table 9 shows the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test clinical specificity results from the
519 evaluable normal subjects. The COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test clinical speci
ficity was 99.4% (516/519; 95% CI = 98.3% to 99.9%). The HIV-1-positive COBAS® AmpliPrep/COBAS®
TaqMan® HIV-1 Test results were all <40 cp/mL.
28
Table 9
COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test Specificity - Evaluable Normal Subjects
® ® ® ®
® COBAS AmpliPrep/COBAS TaqMan HIV-1 COBAS
COBAS ®
® Test Result AmpliPrep/COBAS
AMPLICOR ®
TaqMan HIV-1 Test
HIV-1 MONITOR Total
Clinical
Test, v 1.5 HIV-1 Positive HIV-1 Negative Specificity
Result
(95% Exact CI)
99.4%
HIV-1 Negative 3 (0.6%) 516 (99.4%) 519
(98.3%, 99.9%)
Table 10 shows the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test clinical sensitivity results from the
473 evaluable HIV-1 subjects. The COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test clinical sensitivity
was 98.3% (465/473; 95% CI = 96.7% to 99.3%).
Table 10
® ® ® ®
® COBAS AmpliPrep/COBAS TaqMan HIV-1 COBAS
COBAS ®
® Test Result AmpliPrep/COBAS
AMPLICOR ®
TaqMan HIV-1 Test
HIV-1 MONITOR Total
Clinical
Test, v1.5 HIV-1 Positive HIV-1 Negative Sensitivity
Result
(95% Exact CI)
HIV-1 Positive 465 (98.3%) 8 (1.7%) 473 98.3%
(96.7%, 99.3%)
*All 8 samples that were determined to be positive for HIV-1 by COBAS® AMPLICOR® HIV-1 MONITOR Test, v1.5 but
not by COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test had a low copy number: 6 of the 8 had HIV-1 titers of < 100
cp/mL, 1 had a titer of 253 cp/mL, and the remaining sample had a titer of 479 cp/mL.
Table 11 shows the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test clinical sensitivity by CD4 count
category (<200, 200-500, >500 cells/µL).
Table 11
® ® ® ® ®
COBAS COBAS AmpliPrep/COBAS TaqMan COBAS
® ®
AMPLICOR HIV-1 Test Result AmpliPrep/COBAS
CD4 Count ®
HIV-1 TaqMan HIV-1 Test
Category Total
MONITOR Clinical
(cells/µL) HIV-1 Positive HIV-1 Negative
Test, v1.5 Sensitivity
Result (95% Exact CI)
99.3%
<200 HIV-1 Positive 141 (99.3%) 1 (0.7%) 142
(96.1%, 100.0%)
98.6%
200 – 500 HIV-1 Positive 212 (98.6%) 3 (1.4%) 215
(96.0%, 99.7%)
96.6%
>500 HIV-1 Positive 112 (96.6%) 4 (3.4%) 116
(91.4%, 99.1%)
29
Conclusion
When compared with results from the COBAS® AMPLICOR® HIV-1 MONITOR Test, v1.5, clinical speci
ficity of the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test was 99.4%, and clinical sensitivity was
98.3%, indicating similar performance of both tests. Furthermore, in both fresh and frozen samples, the
COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test showed similar specificity (>98%) and sensitivity
(>98%), indicating comparable test performance for both sample types.
Selection of the HIV-1 samples included in this study was based on a single test result with the COBAS®
AMPLICOR® HIV-1 MONITOR Test, v1.5. For low titer samples, the results from the COBAS®
AMPLICOR® HIV-1 MONITOR Test, v1.5 are subject to large variability (coefficient of variation = 50% at
100 cp/mL). All 8 samples that were determined to be positive for HIV-1 by the COBAS® AMPLICOR®
HIV-1 MONITOR Test, v1.5 but not by the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test had a low
copy number: 6 of the 8 had HIV-1 titers of <100 cp/mL, 1 had a titer of 253 cp/mL, and the remaining
sample had a titer of 479 cp/mL. The COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test was able to
detect 111 out of the 119 samples with titers <480 cp/mL. The observed results are consistent with what
is expected with low-titer samples. Furthermore, the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test
and the COBAS® AMPLICOR® HIV-1 MONITOR Test, v1.5 appeared to show comparable agreement
across the linear range.
The COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Test also showed similar clinical sensitivity among
CD4 count categories (>96% overall), suggesting comparable performance in samples from HIV-1 patients
with various CD4 counts.
30
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ROCHE, AMPERASE, AMPLICOR, AMPLILINK, COBAS, AMPLIPREP, TAQMAN and HIGH PURE are
trademarks of Roche.
ROCHE RESPONSE CENTER is a service mark of Roche.
Armored RNA is a patented technology jointly developed by Ambion, Inc. and Cenetron Diagnostics, LLC.
U.S. patents #5,677,124, #5,919,625, and #5,939,262 and patents pending. Armored RNA® is a reg
istered trademark of Ambion and Cenetron.
Microsoft and Windows XP are either registered trademarks or trademarks of Microsoft Corporation in
the United States and/or other countries.
ProClin is a trademark of Rohm and Haas Company.
VERSANT® is a registered trademark of Bayer Corporation.
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