Antigen-Based Testing but Not Real-Time Polymerase Chain Reaction Correlates With Severe Acute Respiratory Syndrome Coronavirus 2 Viral Culture

• Published in: Clinical Infectious Diseases 2021-11, Vol.73 (9), p.e2861-e2866
• Main Authors: Pekosz, Andrew, Parvu, Valentin, Li, Maggie, Andrews, Jeffrey C, Manabe, Yukari C, Kodsi, Salma, Gary, Devin S, Roger-Dalbert, Celine, Leitch, Jeffry, Cooper, Charles K
• Format: Article
• Language: English
• Subjects: Antigens, Viral; COVID-19; Humans; Online only; Real-Time Polymerase Chain Reaction; SARS-CoV-2; Sensitivity and Specificity
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciaa1706

Abstract Background Individuals can test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by molecular assays following the resolution of their clinical disease. Recent studies indicate that SARS-CoV-2 antigen–based tests are likely to be positive early in the disease course, when there is an increased likelihood of high levels of infectious virus. Methods Upper respiratory specimens from 251 participants with coronavirus disease 2019 symptoms (≤7 days from symptom onset) were prospectively collected and tested with a lateral flow antigen test and a real-time polymerase chain reaction (rt-PCR) assay for detection of SARS-CoV-2. Specimens from a subset of the study specimens were utilized to determine the presence of infectious virus in the VeroE6TMPRSS2 cell culture model. Results The antigen test demonstrated a higher positive predictive value (90%) than rt-PCR (70%) when compared to culture-positive results. The positive percentage agreement for detection of infectious virus for the antigen test was similar to rt-PCR when compared to culture results. Conclusions The correlation between SARS-CoV-2 antigen and SARS-CoV-2 culture positivity represents a significant advancement in determining the risk for potential transmissibility beyond that which can be achieved by detection of SARS-CoV-2 genomic RNA. SARS-CoV-2 antigen testing can facilitate low-cost, scalable, and rapid time-to-result, while providing good risk determination of those who are likely harboring infectious virus, compared to rt-PCR. Antigen-based, real-time polymerase chain reaction (rt-PCR)–based, and VeroE6TMPRSS2 cell culture–based testing was conducted using upper respiratory specimens from COVID-19–symptomatic individuals. Using VeroE6TMPRSS2 culture as reference, antigen-based testing had similar positive percentage agreement but better positive predictive value, compared to rt-PCR, for detecting infectious virus.