Early Diagnosis Of Human Immunodeficiency Virus Infection Research Articles

Reduction of the diagnostic window with a new combined p24 antigen and human immunodeficiency virus antibody screening assay

In order to reduce the window phase between time of human immunodeficiency virus (HIV) infection and laboratory diagnosis, new fourth generation screening assays which permit a simultaneous detection of HIV antigen and antibody have been developed. In a multicenter study, a new automated fourth generation assay, Enzymun-Test® HIV Combi (Boehringer Mannheim GmbH) was compared to third generation assay, p24 antigen tests and Western blot. A total of 37 seroconversion panels, samples of the early infection ( n=42), HIV-1 antibody positive sera, including subtypes A–E, and O ( n=1118), HIV-2 positive samples ( n=252) and cell culture supernatants infected with different HIV-1 subtypes and HIV-2 ( n=50), blood donors ( n=6649), hospitalized patients ( n=475), HIV neg. sera with indeterminate Western blot ( n=32), potentially cross reactive serum samples ( n=435) and HIV negative specimens from Cameroon ( n=68) were tested. A total of 16 of 29 seroconversions were detected on average 8.5 days earlier with Enzymun-Test® HIV Combi than HIV-1/HIV-2 3rd generation EIA (Abbott Laboratories). Overall, in the 29 panels investigated comparatively with the two assays, the mean time delay between Enzymun-Test® HIV Combi and HIV-1/HIV-2 3rd generation EIA was 4.7 days. HIV antigen was detected in three out of 35 seroconversions one bleed earlier with HIV-1 Ag Monoclonal than with Enzymun-Test® HIV Combi. Enzymun-Test® HIV Combi showed a sensitivity of 100% for HIV antibody detection for HIV-1 group M and O and HIV-2 positive specimens. While p24 antigen of different HIV-1 subtypes was detected with Enzymun-Test® HIV Combi in all the 49 cell culture supernatants, HIV Ag was not detected in an HIV-2 virus lysate. A total of 66 false positive results out of 7659 HIV negative samples were obtained with the Enzymun-Test® HIV Combi. The specificity for unselected blood donors was 99.6%. The Enzymun-Test® HIV Combi permits an earlier diagnosis of HIV infection than third generation assays through the detection of p24 antigen, which may be present in serum samples from individuals with recent HIV infection prior to seroconversion and it shows an excellent sensitivity for antibodies to all known HIV-1 subtypes and HIV-2. The specificity in blood donors and hospitalized patients is comparable to that of other assays.

Rapid Testing for HIV Antibody: A Technology Whose Time Has Come

Editorials15 September 1996Rapid Testing for HIV Antibody: A Technology Whose Time Has ComeFreya Spielberg, MD and William J. Kassler, MD, MPHFreya Spielberg, MDUniversity of Washington Seattle, WA 98195Centers for Disease Control and Prevention, Atlanta, GA 30333Search for more papers by this author and William J. Kassler, MD, MPHUniversity of Washington Seattle, WA 98195Centers for Disease Control and Prevention, Atlanta, GA 30333Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-125-6-199609150-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The benefits of widespread voluntary testing for human immunodeficiency virus (HIV) have been recognized since 1985, when the first antibody test for HIV became available. Recently, the reasons to promote the early diagnosis of HIV infection have become even more compelling. Research has shown that knowledge of HIV-positive serostatus combined with counseling can facilitate behavioral change [1], allows for partner notification, and may be a valuable tool in the public response to HIV prevention. In addition, mounting evidence shows that early antiretroviral therapy [2] and antibiotic prophylaxis for opportunistic infections [3] can improve the health of HIV-infected persons. Furthermore, knowledge ...

Early detection of human immunodeficiency virus on dried blood spot specimens: Sensitivity across serial specimens

OBJECTIVE: To evaluate the use of dried blood spot (DBS) specimens and the early diagnostic value of the polymerase chain reaction (PCR) for detection of the human immunodeficiency virus (HIV) in DBS specimens collected at predefined age intervals from a large cohort of U.S. infants at risk of congenital or perinatal HIV infection. DESIGN: We assayed available DBS specimens (n = 272) obtained during the first 4 months of life from 144 infants (41 infected, 103 uninfected) born to HIV-infected mothers enrolled in the Women and Infants Transmission Study. The DBS PCR results were compared with infant HIV infection status, PCR on liquid blood, and viral culture results. Analyses also included sensitivity and specificity of assay as related to the age of the infant when the specimen was obtained. RESULTS: The DBS specimen PCR results were concordant with results from liquid blood specimens and with results from viral culture. The DBS PCR was highly specific for all age groups. Sensitivity in detecting HIV infection status rapidly increased during the first month of life, from 19% (5/26) by 1 week to 96% (25/26) by 1 month of age. Specimens obtained on the day of birth or the next day were the least likely to have detectable HIV DNA. CONCLUSIONS: The PCR assay of DBS specimens is a reliable tool for the early diagnosis of HIV infection and has important advantageover that of liquid blood DNA PCR and viral culture. These advantages include a lower volume of blood required for testing, increased safety, and ease of storage or transport of specimens. Thus DBS PCR is a useful test for clinical and epidemiologic tracking of infants at risk of HIV infection. (J P EDIATR 1996;129:111-8)

Human immunodeficiency virus-specific IgA in infants born to human immunodeficiency virus-seropositive women.

To determine the sensitivity and specificity of human immunodeficiency virus (HIV)-specific IgA for vertically transmitted HIV infection, particularly during the first month of life. Prospective cohort study of 140 infants born to HIV-seropositive women in a large urban teaching hospital and of 248 older infants and children referred for diagnosis and treatment of HIV infection. The HIV-specific IgA immunoblot results were compared with the infection status of patients as determined by Centers for Disease Control and Prevention (Atlanta, Ga) criteria or by sequential early diagnostic assays for HIV. Sensitivity, specificity, and predictive values were calculated for each age range. Among infants studied from birth, the rate of vertical transmission of HIV was 21.6% (25/116). The sensitivity of HIV-specific IgA for the first month of life was 8.0% (2/25), and the specificity was 90.1% (82/91). Sensitivity increased progressively during the first year of life, and the negative predictive value was 94.6% by 6 to 8 months of age. The positive predictive value of this assay was 18.2% for neonates but was 96% to 100% after the first month of life. False-positive test results for HIV-specific IgA occurred with diminishing frequency during the first 4 weeks of life, and the frequency of detectable HIV-specific IgA was similar among the HIV-infected and uninfected groups at this age. Beyond 1 month of age, detection of HIV-specific IgA is highly specific and is a useful serum-based assay for early diagnosis of HIV infection. These results suggest that maternal-fetal transfusion is common and support the hypothesis that the majority of maternal-fetal transmission of HIV occurs around the time of parturition.

Children With Unrecognized Human Immunodeficiency Virus Infection

To provide an approach toward the diagnosis of children with human immunodeficiency virus (HIV) infection in the acute care setting. Patient reports and review of recent literature. Emergency departments or acute care clinics. Analysis of important recent clinical publications. None. The clinical and historical findings associated with pediatric HIV infection are occasionally subtle and differ from those findings in adults. In this article, we have divided the first presentation of HIV in the acute care setting into five categories: recurrent bacterial infections, failure to thrive, unexplained organomegaly, adolescents with HIV, and late presentation of perinatally acquired HIV. Each category is illustrated by a patient treated in the acute care setting. Recognition of these categories of presentation will hopefully assist acute care physicians in the early diagnosis of HIV infection.

Human Immunodeficiency Virus Infection in North American Women

This study was designed to define the epidemiology and natural history of human immunodeficiency virus (HIV) infection in women in Rhode Island. Two hundred women referred to Brown University physicians from 1986 through 1990 were evaluated at 3-to-6-month intervals for 12 to 60 months. All received antiretroviral therapy and prophylaxis against opportunistic infections when indicated on the basis of CD4 lymphocyte counts. Major findings included: 1) rapid shift of dominant mode of transmission from intravenous drug sharing to heterosexual route; 2) significant gender-specific differences in clinical presentation; 3) increased frequency of cervical dysplasia in women infected via intravenous needle sharing; 4) no definite gender-specific differences in progression of HIV infection; 5) enormous societal impact of HIV infection in women. Principal conclusions are: 1) rapid change to predominantly heterosexual HIV transmission can occur in North America, with serious societal impact; 2) gender-specific clinical features can lead to earlier diagnosis of HIV infection in women; 3) HIV infection in women does not pursue an inherently more rapid course than that observed in men.

Cystic parotid masses in HIV infection

Cystic enlargement of the parotid gland is a newly described manifestation of infection with human immunodeficiency virus (HIV). A review of 15 such patients with respect to clinical presentation, natural history, and management is presented. Follow-up ranges from 1 to 27 months, averaging 10 months. In 47% of the patients, parotid swelling was the chief complaint leading to the diagnosis of HIV infection. T-cell analysis revealed the tendency for this lesion to occur in the early stages of immunodeficiency when T-cell counts are high. Histologic examination revealed findings resembling benign lymphoepithelial lesion. It is felt that these lesions are a local manifestation of a systemic disease and treatment should be tailored with this in mind. Surgical excision may not be necessary. Fine-needle aspiration (FNA) was found to be useful diagnostically and therapeutically. Recognition of this entity is essential for the head and neck specialist in providing an early diagnosis of HIV infection.

IN-VITRO PRODUCTION OF HIV-SPECIFIC ANTIBODY IN CHILDREN AT RISK OF AIDS

To improve on the early diagnosis of human immunodeficiency virus (HIV) infection, 37 children born to HIV-infected mothers and 22 controls were investigated for in-vitro synthesis of IgG antibody directed against HIV components. For 14 of 16 infected children western blot showed HIV-specific IgG in the supernatants of cultures of their peripheral blood lymphocyte cultures. HIV-specific IgG synthesis was detected in cultures from 4 out of 17 seropositive children aged under 15 months with no clinical or laboratory evidence of infection. No HIV-specific IgG production was observed in cultures from 4 uninfected children or 22 controls. The results show that the demonstration of in-vitro production of HIV-specific IgG may help in the early diagnosis of HIV infection in children.