Commentary
Establishing the diagnosis of HIV infection: New tests and a new algorithm for the United States

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  • Cited by (30)

    • Trends in testing algorithms used to diagnose HIV infection, 2011–2015, United States and 6 dependent areas

      2018, Journal of Clinical Virology
      Citation Excerpt :

      As a result, a second level of testing was added to improve specificity, and by 1989 the most commonly used HIV diagnostic testing algorithm consisted of an HIV antibody immunoassay (IA) as the initial test, followed by a Western blot (WB) or immunofluorescence assay (IFA) as the supplemental antibody test to confirm reactive results from the initial test [11]. In 2014 the Centers for Disease Control and Prevention (CDC) and the Association of Public Health Laboratories (APHL) issued updated laboratory testing recommendations for the diagnosis of HIV infection to improve the recognition of acute HIV-1 infections and to reduce the time to make a definitive determination of a patient's HIV status [12–16]. The 2014 algorithm consists of an HIV-1 IA that can detect both HIV antigen and antibody, followed by a supplemental IA that can detect HIV antibodies and differentiates between HIV-1 and HIV-2 antibodies.

    • Performance of a parallel diagnostic algorithm for HIV diagnosis in low risk pediatric and obstetric patient populations

      2014, Journal of Clinical Virology
      Citation Excerpt :

      For the past two decades the diagnosis of HIV infection has been based on a testing algorithm that included an initial screen using an enzyme immunoassay (EIA) followed by confirmatory testing with either a Western blot (WB), or an indirect immunofluorescence assay (IFA) [2–6]. Although results of this algorithmic approach are highly specific, the ability of WB to detect only IgG antibodies can result in failure to diagnose acute and early HIV infection, resulting in delays in appropriate prompt retroviral therapy and leading to an increased risk of onward HIV transmission, thereby sustaining the HIV epidemic [7–10]. Additionally, the frequent indeterminate results from the HIV-1 WB and the inability to differentiate HIV-1 from HIV-2 infections results in delays in confirmation, and may result in delays in the appropriate initiation of therapy for a significant number of patients [11,12].

    • Evaluation in a clinical setting of the performances of a new rapid confirmatory assay for HIV1/2 serodiagnosis

      2014, Journal of Clinical Virology
      Citation Excerpt :

      Confirmation of HIV serodiagnosis has been performed for more than 20 years with labour-intensive Western blot (WB) techniques [3], but there is a recognised necessity to speed the turnaround time (TAT) for this step. Recent revisions of HIV diagnostic algorithms highlighted the challenge to identify acute HIV infection (AHI) and HIV-2 [4–6]. AHI is characterized by positive HIV nucleic acid testing and negative/indeterminate WB [7].

    • Pooled nucleic acid testing increases the diagnostic yield of acute HIV infections in a high-risk population compared to 3rd and 4th generation HIV enzyme immunoassays

      2014, Journal of Clinical Virology
      Citation Excerpt :

      Specimens non-reactive by 3rd gen, but reactive by 4th gen EIA or positive by PNAT are not routinely tested by WB. WB is not useful for HIV confirmation in these cases due to the longer window period of WB compared to current 3rd and 4th gen EIAs [7,9]. All EIAs and PNAT was conducted on fresh specimens which had not been frozen.

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