Aiswarya A Ramanujam_Thesis.pdf

As of 2021, 38.4 million people worldwide are living with Human Immunodeficiency virus (HIV), with eastern and southern Africa having the highest prevalence. The efficacy of treatment is determined by identifying acute HIV infections (AHI) and prompting early antiretroviral therapy (ART) initiation to achieve viral suppression and reduce the risk of transmission. Existing rapid tests that detect host antibodies are affected by long seroconversions which allow the viruses to remain undetected until long after infection. On the contrary, highly sensitive nucleic acid amplification test (NAAT) based assays, serving as the gold standard for detection are restricted by their long turnaround time and high cost of implementation thus, restricting their use in low resource settings. Further, drug resistance cases and patient non-compliance to treatment may lead to HIV progression to aids; therefore, effective viral load monitoring is a critical component in the HIV care continuum. To address the gaps in viral load monitoring and early HIV detection, I propose to develop assays for handheld self-test platforms to detect low concentrations of HIV via two different approaches: 1) I will optimize an existing NAAT - based assay to semi-quantitatively detect HIV particles that were spiked in clinical samples and 2) I will Investigate the binding kinetics between HIV p24 antigen and Anti-HIV-1 p24 Antibody using the principle of Bio-layer Interferometry. Thus, I will lay the foundation for the development of a novel and highly sensitive p24 detection assay. Overall, this work will enable detection of ahi detection as well as support people living with HIV (PLHIV) management, all while remaining connected to healthcare and provider support.