Share This Article:

HIV Diagnosis in Resource Constrained Setting: How Good Is the Current Algorithm?

Abstract Full-Text HTML Download Download as PDF (Size:629KB) PP. 45-51
DOI: 10.4236/wja.2014.41006    2,999 Downloads   3,983 Views   Citations

ABSTRACT

Background: The conventional HIV testing algorithm in most of the developed countries consists of two tests: an HIV enzyme immunoassay capable of identifying HIV-1 and HIV-2 antibodies and a confirmatory HIV-1 Western blot or immunofluorescence assay. However, the current algorithm for HIV diagnosis in India uses three sequential antibody assays. There has always been doubt regarding the benefits of this algorithm. Objective: To determine the utility of the current diagnostic algorithm and to find out the proportion of indeterminate or discrepant results. Methods: Retrospective analysis of HIV antibody testing data was carried out over a period of five years after institutional ethics committee approval. The specimens positive with the screening test and negative with both the supplemental tests were labeled as discrepant. Specimens positive with any of the two tests (screening and one of the supplemental tests) and negative with the remaining supplemental test were labeled as indeterminate. These indeterminate specimens were confirmed by immunoblotting. Results: A total of 141,296 samples were tested. Of these, 71 (0.05%) samples were indeterminate and 292 (0.21%) were discrepant. Western blot was done on 60 indeterminate samples of which 10 (16.67%) were positive for HIV 1 antibodies, 14 (23.33%) were negative for HIV antibodies and 36 (60%) had indeterminate result. Conclusion: In view of the low numbers of indeterminate and discrepant results, the current algorithm appears to be appropriate in our resource constrained setting. However, the algorithm for HIV testing should also include DNA PCR testing facility to resolve western blot indeterminate results.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Ingole, N. , Sarkate, P. , Paranjpe, S. , Sarode, R. , Shinde, S. and Mehta, P. (2014) HIV Diagnosis in Resource Constrained Setting: How Good Is the Current Algorithm?. World Journal of AIDS, 4, 45-51. doi: 10.4236/wja.2014.41006.

References

[1] Guidelines on HIV Testing (2007) National AIDS Control Organisation, Ministry of Health and Family Welfare, Government of India.
http://naco.gov.in/upload/Policies%20&%20Guidelines/5-GUILDELINES%20FOR%20HIV%20TESTING.pdf
[2] Centers for Disease Control and Prevention (2009) HIV Testing Implementation Guidance for Correctional Settings.
http://stacks.cdc.gov/view/cdc/5279
[3] Mounier-Jack, S., Nielsen, S. and Coker, R.J. (2008) HIV Testing Strategies across European Countries. HIV Medicine, 9, 13-19. http://dx.doi.org/10.1111/j.1468-1293.2008.00585.x
[4] Ren, A., Louie, B., Rauch, L., Castro, L., Liska, S., Klausner, J.D., et al. (2008) Screening and Confirmation of Human Immunodeficiency Virus Type 1 Infection Solely by Detection of RNA. Journal of Medical Microbiology, 57, 1228-1233. http://dx.doi.org/10.1099/jmm.0.2008/002386-0
[5] WHO/CDC/APHL (2002) Guidelines for Appropriate Evaluations of HIV Testing Technologies in Africa. Geneva. http://whqlibdoc.who.int/afro/2002/a82959_eng.pdf
[6] Roy, S., Fitz-Gibbon, L., Spira, B., Portnoy, J. and Wainberg, M.A. (1987) False-Positive Results of Confirmatory Testing for Antibody to HIV-I. CMAJ, 136, 612-614.
[7] Syed Iqbal, H., Balakrishnan, P., Solomon, S.S., Murugavel, K.G., Kumarasamy, N., Vidya, S., et al. (2005) HIV 1 Western Blot Assay: What Determines an Indeterminate Status? Indian Journal of Medical Sciences, 59, 443-450.
http://dx.doi.org/10.4103/0019-5359.17051
[8] Owen, S.M., Yang, C., Spira, T., Ou, C.Y., Pau, C.P., Parekh, B.S., et al. (2008) Alternative Algorithms for Human Immunodeficiency Virus Infection Diagnosis Using Tests That Are Licensed in the United States. Journal of Clinical Microbiology, 46, 1588-1595. http://dx.doi.org/10.1128/JCM.02196-07
[9] Grusky, O., Roberts, K.J. and Swanson, A.N. (2006) Communicating Indeterminate Hiv Western Blot Test Results to Clients: An Observational Study of Three Community Testing Sites. AIDS Patient Care STDS, 20, 620-627.
http://dx.doi.org/10.1089/apc.2006.20.620
[10] Hecht, F.M., Busch, M.P., Rawal, B., Webb, M., Rosenberg, E., Swanson, M., et al. (2002) Use of Laboratory Tests and Clinical Symptoms for Identification of Primary HIV Infection. AIDS, 16, 1119-1129.
http://dx.doi.org/10.1097/00002030-200205240-00005
[11] Henrard, D.R., Phillips, J., Windsor, I., Fortenberry, D., Korte, L., Fang, C., et al. (1994) Detection of Human Immunodeficiency Virus Type 1 p24 Antigen and Plasma RNA: Relevance to Indeterminate Serologic Tests. Transfusion, 34, 376-380.
http://dx.doi.org/10.1046/j.1537-2995.1994.34594249046.x
[12] Soroka, S.D., Granade, T.C., Candal, D. and Parekh, B.S. (2005) Modification of Rapid Human Immunodeficiency Virus (HIV) Antibody Assay Protocols for Detecting Recent HIV Seroconversion. Clinical and Diagnostic Laboratory Immunology, 12, 918-921.
[13] Doran, T.I. and Parra, E. (2000) 25 False-Positive and Indeterminate Human Immunodeficiency Virus Test Results in Pregnant Women. Archives of Family Medicine, 9, 924-929.
http://dx.doi.org/10.1001/archfami.9.9.924
[14] Gasasira, A.F., Dorsey, G., Kamya, M.R., Havlir, D., Kiggundu, M., Rosenthal, P.J., et al. (2006) False-Positive Results of Enzyme Immunoassays for Human Immunodeficiency Virus in Patients with Uncomplicated Malaria. Journal of Clinical Microbiology, 44, 3021-3024.
http://dx.doi.org/10.1128/JCM.02207-05
[15] Lee, D.A., Eby, W.C. and Molinaro, G.A. (1992) HIV False Positivity after Hepatitis B Vaccination. Lancet, 339, 1060.
http://dx.doi.org/10.1016/0140-6736(92)90586-R
[16] Rompalo, A.M., Cannon, R.O., Quinn, T.C. and Hook, E.W. (1992) Association of Biologic False-Positive Reactions for Syphilis with Human Immunodeficiency Virus Infection. The Journal of Infectious Diseases, 165, 1124-1126.
http://dx.doi.org/10.1093/infdis/165.6.1124
[17] Watt, G., Chanbancherd, P. and Brown, A.E. (2000) Human Immunodeficiency Virus Type 1 Test Results in Patients with Malaria and Dengue Infections. Clinical Infectious Diseases, 30, 25-29.
[18] Thakral, B., Saluja, K., Sharma, R.R. and Marwaha, N. (2006) Algorithm for Recall of HIV Reactive Indian Blood Donors by Sequential Immunoassays Enables Selective Donor Referral for Counseling. Journal of Postgraduate Medicine, 52, 106-109.
[19] Boeras, D.I., Luisi, N., Karita, E., McKinney, S., Sharkey, T., Keeling, M., et al. (2011) Indeterminate and Discrepant Rapid HIV Test Results in Couples’ HIV Testing and Counselling Centres in Africa. Journal of the International AIDS Society, 14, 18. http://dx.doi.org/10.1186/1758-2652-14-18
[20] Talal, N., Flescher, E. and Dang, H. (1992) Are Endogenous Retroviruses Involved in Human Autoimmune Disease? Journal of Autoimmunity, 5, 61-66. http://dx.doi.org/10.1016/0896-8411(92)90020-Q
[21] Talal, N., Dauphinee, M.J., Dang, H., Alexander, S.S., Hart, D.J. and Garry, R.F. (1990) Detection of Serum Antibodies to Retroviral Proteins in Patients with Primary Sjogren’s Syndrome (Autoimmune Exocrinopathy). Arthritis & Rheumatology, 33, 774-781. http://dx.doi.org/10.1002/art.1780330603
[22] Talal, N., Garry, R.F., Schur, P.H., Alexander, S., Dauphinee, M.J., Livas, I.H., et al. (1990) Conserved Idiotype and Antibodies to Retroviral Proteins in Systemic Lupus Erythematosus. Journal of Clinical Investigation, 85, 1866-1871.
http://dx.doi.org/10.1172/JCI114647
[23] Urnovitz, H.B., Sturge, J.C., Gottfried, T.D. and Murphy, W.H. (1999) Urine Antibody Tests: New Insights into the Dynamics of HIV-1 Infection. Clinical Chemistry, 45, 1602-1613.
[24] Vardinon, N., Yust, I., Katz, O., Iaina, A., Katzir, Z., Modai, D., et al. (1999) Anti-HIV Indeterminate Western Blot in Dialysis Patients: A Long-Term Follow-Up. American Journal of Kidney Diseases, 34, 146-149.
http://dx.doi.org/10.1016/S0272-6386(99)70121-6
[25] Sethoe, S.Y., Ling, A.E., Sng, E.H., Monteiro, E.H. and Chan, R.K. (1995) PCR as a Confirmatory Test for Human Immunodeficiency Virus Type 1 Infection in Individuals with Indeterminate Western Blot (Immunoblot) Profiles. Journal of Clinical Microbiology, 33, 3034-3036.
[26] Dock, N.L., Kleinman, S.H., Rayfield, M.A., Schable, C.A., Williams, A.E. and Dodd, R.Y. (1991) Human Immunodeficiency Virus Infection and Indeterminate Western Blot Patterns. Prospective Studies in a Low Prevalence Population. Archives of Internal Medicine, 151, 525-530.
http://dx.doi.org/10.1001/archinte.1991.00400030077014
[27] Genesca, J., Shih, J.W., Jett, B.W., Hewlett, I.K., Epstein, J.S. and Alter, H.J. (1989) What Do Western Blot Indeterminate Patterns for Human Immunodeficiency Virus Mean in EIA-Negative Blood Donors? Lancet, 28, 1023-1025.
http://dx.doi.org/10.1016/S0140-6736(89)91027-1
[28] Jackson, J.B., MacDonald, K.L., Cadwell, J., Sullivan, C., Kline, W.E., Hanson, M., et al. (1990) Absence of HIV Infection in Blood Donors with Indeterminate Western Blot Tests for Antibody to HIV-1. The New England Journal of Medicine, 322, 217-222. http://dx.doi.org/10.1056/NEJM199001253220402
[29] Jackson, J.B., Hanson, M.R., Johnson, G.M., Spahlinger, T.G., Polesky, H.F. and Bowman, R.J. (1995) Long-Term Follow-Up of Blood Donors with Indeterminate Human Immunodeficiency Virus Type 1 Results on Western Blot. Transfusion, 35, 98-102. http://dx.doi.org/10.1046/j.1537-2995.
1995.35295125746.x
[30] Josephson, S.L., Swack, N.S., Ramirez, M.T. and Hausler Jr., W.J. (1989) Investigation of Atypical Western Blot (Immunoblot) Reactivity Involving Core Proteins of Human Immunodeficiency Virus Type 1. Journal of Clinical Microbiology, 27, 932-937.
[31] Centers for Disease Control and Prevention (2001) Revised Guidelines for HIV Counseling, Testing, and Referral and Revised Recommendations for HIV Screening of Pregnant Women—United States. Morbidity and Mortality Weekly Report, 50, 63-85.
[32] Behets, F., Disasi, A., Ryder, R.W., Bishagara, K., Piot, P., Kashamuka, M., et al. (1991) Comparison of Five Commercial Enzyme-Linked Immunosorbent Assays and Western Immunoblotting for Human Immunodeficiency Virus Antibody Detection in Serum Samples from Central Africa. Journal of Clinical Microbiology, 29, 2280-2284.
[33] Carneiro-Proietti, A.B., Cunha, I.W., Souza, M.M., Oliveira, D.R., Mesquita, N.M., Andrade, C.A., et al. (1999) HIV-(1/2) Indeterminate Western Blot Results: Follow-Up of Asymptomatic Blood Donors in Belo Horizonte, Minas Gerais, Brazil. Revista do Instituto de Medicina Tropical de S?o Paulo, 41, 155-158.
http://dx.doi.org/10.1590/S0036-46651999000300004
[34] Kopko, P., Calhoun, L. and Petz, L. (1999) Distinguishing Immunosilent AIDS from the Acute Retroviral Syndrome in a Frequent Blood Donor. Transfusion, 39, 383-386. http://dx.doi.org/10.1046/j.1537-2995.1999.39499235670.x

  
comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.