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Serological assays to distinguish recent (,4–6 months) and established (¢4–6 months) infections using a single specimen from individuals newly diagnosed with human immunodeficiency virus (HIV) have become increasingly popular as part of HIV surveillance (Murphy & Parry, 2008). These RITA (Recent Infection Testing Algorithm) assays enable more in-depth understanding of HIV transmission, and allow better estimations of HIV incidence and the identification of risk factors for recent infections (RIs). Current assays are based on the evolving immunological response over time. An example is an assay that determines the avidity index (AI) for anti-HIV antibodies by adding a denaturing agent that disturbs the binding of low-avidity antibodies (Suligoi et al., 2011). The increasing affinity of antibodies after an infection results in a higher AI over time.

Evaluation of a fourth-generation avidity assay for recent HIV infections among men who have sex with men in Amsterdam