Human Immunodeficiency Virus Screening Tests Research Articles

A different form of injury prevention: Successful screening and referral for human immunodeficiency virus and hepatitis C virus in a trauma population.

In the United States, millions of patients are living with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) (0.44% and 1.5%) and many are currently undiagnosed. Because highly effective treatments are now available, early identification of these patients is extremely important to achieve improved clinical outcomes. Prior data and trauma-associated risk factors suggest a higher prevalence of both diseases in the trauma population. We hypothesized that a screening program could be successfully initiated among trauma activation patients and that a referral and linkage-to-care program could be developed. Hepatitis C virus and HIV screening tests were added to standard trauma activation laboratory orders at an academic Level I Trauma Center. Confirmatory viral load was sent when indicated. Patients with positive results were educated about their disease and referred to disease-specific follow-up. Data were collected prospectively from January 1, 2016, until June 30, 2017. Total and new diagnosis, referral rates, and linkage-to-care rates were analyzed. One thousand eight hundred ninety-eight patients arrived as trauma activations. One thousand two hundred seventeen (64.1%) patients were screened (Level A, 75.6%; Level B, 60.2%). Seven percent of the screened patients were initially positive, and 5.5% were confirmed positive. Rates of both HIV (1.1%) and HCV (4.4%) were almost triple the national average. Overall, 3.3% screened positive for a new diagnosis. For HCV, the rate of new diagnosis was twice the national average (3%). Over 85% of all cases were referred for follow-up, and the combined linkage-to-care rate was 43.3%. The majority of patients were screened and referred for follow-up, indicating successful implementation of our trauma screening program. Routine screening of trauma patients should be considered to increase diagnosis rate, increase linkage-to-care rates, and decrease disease transmission. These screening efforts would help bridge the health care gap that exists in the trauma population due to lower insurance rates and limited access to primary care. Therapeutic/Care management, level III.

Le rôle des facteurs psychologiques dans la réalisation d’une démarche de dépistage du VIH

ObjectivesDespite of regional, national and international plans which have been implemented to struggle against the Human Immunodeficiency Virus (HIV), the global prevalence of this disease continues to increase. While the General Assembly of the United Nations is aiming at putting an end to the Acquired Immune Deficiency Syndrome (AIDS) epidemic in the world by 2030, it appears necessary to draw up the list of the main factors involved in the HIV test process. Indeed, a better knowledge of the factors, facilitating or hindering the uptake of a HIV screening test, enables to make more effective prevention campaigns which aim at improving people's knowledge of their serological status. The purpose of this article is to underline the impact of psychological factors involved in the HIV test process. From the literature reviews already established, the main psychological factors, facilitating or hindering the uptake of a HIV screening test have been identified. MethodsThe databases PsycINFO, PsycARTICLES, MEDLINE, Psychology and Behavioral Sciences Collection were consulted between March 2016 and February 2017, with the use of key words, to search for articles published between 2005 and 2017 on the main levers and barriers to HIV testing. From the 332 references listed with these criteria, 25 articles were retained including 5 articles in which the authors make literature reviews or meta-analyses. ResultsThe main levers and barriers to HIV testing noted in the literature are socio-demographic, contextual, relational, or related to more psychological factors: behavioral, cognitive and emotional factors. Concerning socio-demographic factors, having a high level of education and suffering from the symptoms of sexually transmitted diseases facilitate HIV testing. Among behavioral factors, the main barrier to HIV testing is having previously realized a negative test, while the main lever is being involved in high-risk behaviors (multiple partners, drug injection). At cognitive level, the main barriers are: minimizing the personal risk incurred, not being well aware the usefulness of the HIV testing, lacking of knowledge about modes of transmission, HIV testing and treatments, ignoring where HIV testing centers are. Conversely, knowing the benefits of treatment, having HIV education and a positive attitude towards HIV testing are HIV testing facilitators. Concerning emotional factors, the main obstacles to the realization of HIV screening are the fear of results, the fear of stigma and discrimination related to HIV status or HIV testing, and the fear of lack of confidentiality. ConclusionsPsychological factors (behavioral, cognitive and emotional) are largely involved in adherence to the screening process, with socio-demographic factors. These results show the impossibility of isolating the different factors potentially involved in the screening process to account for the complexity of human behavior in such a context. The decision of submitting oneself to HIV testing is therefore part of the Transactional, Integrative and Multifactorial Model. Otherwise, the study of the literature reveals that research on the psychological factors associated with HIV testing are essentially cross-sectional and that none of them studies the involvement of psychological factors in the context of screening. This topic, which is the subject of ongoing research, deserves to be studied to better understand the implication of psychological factors once the decision is taken to carry out an HIV test.

Scaling Up Human Immunodeficiency Virus Screening and Antiretroviral Therapy Among Men Who Have Sex With Men to Achieve the 90-90-90 Targets in China.

The Joint United Nations Programme on human immunodeficiency virus (HIV)/acquired immune deficiency syndrome has proposed the 90-90-90 targets by 2020. Human immunodeficiency virus epidemic is spreading rapidly among men who have sex with men (MSM) in China. This study investigates how the scale-up of HIV testing and treatment in achieving the targets and its cost-effectiveness. We constructed a compartmental model to forecast the HIV epidemic in Chinese MSM based on various "test-and-treat" scale-up scenarios. We assessed their cost effectiveness based on the cost for each HIV infection, death, and disability-adjusted life years (DALYs) prevented by the scale-up. If the current epidemic continued, HIV prevalence among Chinese MSM would increase from 9.2% in 2016 to 12.6% (9.2-15.6%) in 2020 and 16.2% (11.3-20.0%) in 2025. By 2020, 49.2% of infected MSM would be diagnosed and 40.1% of whom on treatment, falling short of the 90-90-90 targets, so would be even by 2025. To achieve these targets by 2020, additional 850,000 HIV screening tests and 112,500 person-years of antiretroviral treatment (ART) annually are necessary. This spending is US $478 million during 2016 to 2020, which almost tripled the status quo. However, by delaying to 2025, an investment of US $1210 million over 2016 to 2025 corresponding to 52% increase to the status quo, will enable extra 340,000 HIV screening tests and 60,000 person-year on ART annually. In both scenarios, the incremental cost-effectiveness ratio was US $733 to 960 for each DALY prevented, indicating highly cost-effective scenarios. Achieving the 90-90-90 targets by 2020 requires steep increase in investment, but delaying the targets to 2025 is practical and cost-effective.

Cost-Effectiveness of Voluntary HIV Testing Strategies in a Very Low-Prevalence Country, the Republic of Korea.

BackgroundThe Republic of Korea has a very low prevalence of human immunodeficiency virus (HIV) infection, but the number of new HIV diagnoses has steadily risen, strongly indicating a large number of undetected HIV infections. Thus, it is important for Korean public health authorities to adopt and encourage cost-effective HIV detection tools, such as rapid HIV screening tests. In this study, we aimed to evaluate the cost-effectiveness of enzyme-linked immunosorbent assays (ELISA) and rapid tests in a public health center (PHC) setting.MethodsWe developed a decision analytic model to assess the per-examinee cost and the cost-effectiveness of identifying HIV patients in a PHC setting using two HIV testing strategies: conventional HIV screening by ELISA versus rapid HIV testing. Analysis was performed in two scenarios: HIV testing in an average-risk population and in a high-risk population.ResultsCompared to the ELISA, the rapid test was cost-saving and cost-effective. The per-examinee cost was USD 1.61 with rapid testing versus USD 3.38 with ELISA in an average-risk population, and USD 4.77 with rapid testing versus USD 7.62 with ELISA in a high-risk population. The cost of identifying a previously undiagnosed HIV case was USD 26,974 with rapid testing versus USD 42,237 with ELISA in an average-risk population, and USD 153 with rapid testing versus USD 183 with ELISA in a high-risk population.ConclusionRapid testing would be more cost-effective than using conventional ELISA testing for identifying previously undiagnosed HIV-infected cases in Korea, a country with extremely low HIV prevalence.

The Frequency of Hepatitis B Virus, Hepatitis C Virus and Human Immunodeficiency Virus Infections among Patients with Schizophrenia in a Mental Health Hospital in Turkey

OZ Objective: Several studies have demonstrated that psychiatric patients are at increased risk for hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections compared the general population. The aim of this study was to determine the frequency of HBV, HCV and HIV infections among patients with schizophrenia in Elazig Mental Health Hospital in Turkey. Materials and Methods: Screening tests for HBV, HCV and HIV have been routinely performed in patients with schizophrenia. Hepatitis B surface antigen (HBsAg), anti-hepatitis B surface (anti-HBs), anti-HCV and anti-HIV tests were performed by the ELISA technique. Results: Four hundred and eighty-nine patients with schizophrenia in the mental health hospital were screened for HBsAg, anti-HBs, anti-HCV and anti-HIV. The study population was consisted of 409 male and 80 female patients. Overall seroprevalence was detected as 6.5% for HBsAg, 41.5% for anti-HBs and 0.2% for anti-HCV. All patients were found to be anti-HIV-negative. Conclusion: This study showed that the frequency of HBV, HCV and HIV infections among patients with schizophrenia was no higher than in the general population. Screening for blood-borne pathogens at the time of admission to the hospital is an important strategy to identify infected residents. Furthermore, hepatitis

Infecţia HIV la nou-născut şi sugar – diagnostic de laborator

AIDS was reported in the pediatric population for the first time in 1982 in the USA by pediatricians who hardly managed to convince those responsible for childcare, because it can also occur in this population segment. Thanks to efforts for disease recognition in the pediatric population, scientists have been able to provide support and children infected with human immunodeficiency virus (HIV) receive the same treatment protocol as adults. Early detection of HIV infection in pregnant women leads to the possibility for starting a treatment to prevent HIV transmission from mother to child. The ELISA test has a high sensitivity and is indicated for HIV screening and Western Blot test has highly specificity and confirming the HIV infection.

Introducing routine HIV screening for patients on an internal medicine residency inpatient service: a quality improvement project

The US Centers for Disease Control and Prevention (CDC) recommend human immunodeficiency virus (HIV) screening for all persons aged 13 to 64 years who present to a health care provider....

Kidney Paired Donation Protocol for Participating Donors 2014.

Kidney Paired Donation Protocol for Participating Donors 2014.

Oral Hairy Leukoplakia in Patient with Human Immunodeficiency Virus Infection

Oral hairy leukoplakia occurs on the lateral surface of the tongue that clinically as an asymptomatic white lesion. It is mainly found in patient with human immunodeficiency virus infection. However, it rarely outbreak immunosuppressed patients after organ transplantation, or the patients taking steroids or immunosuppressants. It is the result of proliferating Epstein-Barr virus in the oral epithelium. Most of human immunodeficiency virus infected patients with oral hairy leukoplakia are highly contagious and possible to progress acquired immunodeficiency syndrome. Therefore, the early diagnosis of oral hairy leukoplakia is very important. Taking a thorough history and human immunodeficiency virus screening test is highly recommended in case oral hairy leukoplakia is detected. In this case, a 29-year-old man presented with whitish lesion on lateral border of tongue is diagnosed as oral hairy leukoplakia and human immunodeficiency virus infection.

Comparison of Spot Urine Protein/Creatinine Ratio, Spot Urine Protein/Osmolality Ratio with Measured 24-Hour Urine Protein in HIV Subjects in Nigeria

Background and Objectives: Urine protein examination is a veritable tool in the management of renal diseases. Proteinuria evaluation from 24-hour urine collection is the gold standard. Prompt urine protein assessment from spot urine sample has become necessary to eliminate inaccuracies inherent in timed urine collection. This study aims at comparing spot urine protein/creatinine ratio (SUPCR) and measured 24-hour urine protein (24 HUP), and also spot urine protein/osmolality ratio (SUPOR) and 24 HUP against measured 24-hour urine protein (24 HUP) for assessment of proteinuria in human immunodeficiency virus (HIV) subjects. Methodology: Three hundred and ninety three HIV subjects from the HIV/AIDS clinic and 136 age- and sexmatched non-HIV subjects as Control. Investigations performed included 24-hour urine protein (24 HUP), spot urine protein (SUP), spot urine creatinine (SUCr), spot urine osmolality (SUOsm), fasting blood sugar (FBS), urinalysis, HIV screening and confirmatory test, electrolyte, urea and creatinine. SUPCR and SUPOR were calculated. Correlation statistics, 2 × 2 contingency table analysis, receiver operator characteristics (ROC) Curve analysis and Bland Altman plots were used to compare SUPCR and 24 HUP, and also SUPOR and 24 HUP in HIV subjects and control. SPSS version 17 and Medcal statistical software were used to analyze the data. P<0.050 was taken as statistically significant. Results: Using the 2 × 2 contingency table in the HIV subjects, the Sensitivity for SUPCR and SUPOR with 24 HUP was 43.4% and 11.5% respectively. Specificity for SUPCR and SUPOR with 24 HUP was 92.9% and 99.2% respectively. The SUPCR had a correlation (r) of 0.734 (p<0.001) with 24 HUP. In addition, SUPOR had a correlation coefficient of 0.417 (p<0.001) with 24 HUP. Using the Bland Altman plots, SUPCR compared with 24HUP the limits of agreement were +0.361 g/day to -0.248 g/day in HIV subjects. In addition for SUPOR the limits of agreements were +0.440 g/day to-0.180 g/day in HIV subjects. The bias was 0.060 g/day and 0.130 g/day for SUPCR and SUPOR respectively. The receiver operating characteristics (ROC) curve showed that SUPCR randomly chosen value of 0.042 mg/mg and SUPOR chosen value of 0.010 mg/dl/mOsm/kg H2O predicted 24 HUP at urinary excretion threshold of 0.150 g. Conclusion: The SUPCR and SUPOR are reliable tests, for quantifying proteinuria in HIV subjects, and should be used in assessment of proteinuria in HIV subjects in Sub Saharan African countries.

新たに開発された第4 世代HIV 迅速診断試薬の性能評価

Extremely early diagnosis of human immunodeficiency virus (HIV) infection has been considered highly important for its treatment. We conducted a performance assessment of a newly developed rapid diagnostic reagent for HIV by using a fourth-generation immunochromatographic assay (Alere HIV Combo). We used whole-blood, plasma, and serum samples obtained from 250 Japanese adults who visited the Kawasaki Medical School Hospital and underwent HIV screening tests. We also used 12 types of commercial HIV-1 sero- conversion panels and World Health Organization standard antigens. This method, which has a detection sensitivity of 100% and a specificity of 99.3%, was as accurate as the chemiluminescent immunoassay (CLIA) method. In a sensitivity test using seroconversion panels in the early phase of infection, the mean duration until positive conversion was 19.3 days. With this method having a high detection sensitivity for HIV-1p24 antigen, the results from whole-blood samples were the same as those from plasma and serum samples. Therefore, it can be considered as a useful rapid measurement method for general practice.

IDENTIFICAÇÃO DO VÍRUS HIV COM METODOLOGIAS DE QUARTA GERAÇÃO

Backgound and Objectives: Since its introduction in the mid-1980s, HIV testing has gradually improved in terms of sensitivity and specificity. A study was carried out to assess the techniques used in a hemotherapy center for human immunodeficiency virus (HIV) identification using two 4th-generation enzyme-linked immunosorbent assay (ELISA) methods. Methods: descriptive and retrospective study of 4th-generation ELISA techniques, which analyzed all the results generated from blood samples obtained from donors aged 16 to 68 years, according to current legislation, who attended a regional blood bank from November 2010 to October 2011. Results: Of 8,475 samples collected through blood donation, 06 were positive or inconclusive at the screening tests and were then analyzed through Western Blot confirmatory test, which confirmed one of them was reagent for the virus. Conclusion: Several factors influence positive results of screening samples, such as type of test used, the immunological window, use of antiretroviral drugs, and personal biological factors of infected individuals. The effectiveness of HIV screening tests should be determined and the methodology improved, so that it can establish with certainty the existence or not of contamination of blood products that will be used later. More research is needed to constantly improve the screening tests and give adequate emphasis to factors that have shown to alter results.

Patient Perceptions of HIV Testing in a Non-Urban Emergency Department's Express Care

Introduction This study evaluated participants' acceptance of rapid Human Immunodeficiency Virus (HIV) testing in the express care of an emergency department (ED) located in a semi-rural, low HIV prevalence area. Methods This was a cross-sectional survey performed in an ED's express care that serves an area with an estimated HIV prevalence of &lt;1%. The survey included 10 questions with answers recorded on a 5-point Likert scale ranging from “strongly disagree” to “strongly agree.” Adult English speaking patients, ages 18 to 64 years, who provided consent, were included. Participants were offered a finger-stick rapid HIV screening test but testing was not required for participation. Results A total of 117 participants were enrolled with 71 tested for HIV with no positive results. Participants demonstrated a preference for testing at a PCP's office, although testing in the ED was acceptable to them. They denied negative emotional response about an offer of HIV testing in the ED and did not desire more information about HIV or testing. Conclusions Despite the low prevalence and semi-rural study area, participants were receptive to HIV testing in the ED.

Point of care (POCT) testing for human immunodeficiency virus (HIV) infection in Australia: in context

The laboratory diagnosis of HIV infection is most often made by the detection of antibodies to the virus. Conventional serologi-cal tests for detection HIV antibodies are usually referred to as ‘screening or standard’ tests (the initial test) or ‘confirmatory, supplemental or reference tests’. Screening tests identify samples that contain antibodies to HIV but are usually not used to provide a presumptive diagnosis for a patient whose sample is found to be initially reactive. Only after confirmatory or reference tests have been performed can an individual conclusively be identified as being seropositive and having established HIV infection. Screening and confirmatory tests are performed in a testing strategy which has been scientifically validated for a particular population demographic to provide the most sensitive and specific result for the individual tested. For many years, point of care (PoCT, rapid or short incubation) tests for HIV have been successfully used in many developed and developing countries. In 2012, the US Food and Drug Administration (FDA) announced the approval of a home test or over-the-counter HIV PoCT that would enable individuals to perform self-testing. In many countries the use of rapid tests has overcome resource constraints where laboratory infrastructure and sample transportation logistics are limited, in remote settings and in populations where the return rate for receiving a confirmed result is poor. Recent research suggests that much HIV transmission occurs from people who have themselves only recently have become infected. Many approaches have been tried to increase the demand for testing and improve rates of testing amongst people at risk of acquiring HIV. There is a strong case of for the introduction of PoCT for HIV in Australia including the desire to improve the rates of testing for populations at risk of infection. Reducing barriers around testing through improving access and consumer experiences suggests that more convenient testing could increase the rates of testing and stimulate the demand for HIV testing in target groups. In Australia, all in vitro diagnostic devices (IVD) are regulated according to a public health risk stratification. Currently all HIV and HCV screening tests are classified in the highest category (Class 4) and undergo a high degree of scrutiny before they are approved for registration on the Australian Register of Therapeutic Goods (ARTG) and approved for sale. This ensures that tests that are available in the Australian market are of a high standard. At the time this abstract was prepared there were two PoCT tests approved on the ARTG; however, one test was approved for use as a screening test and could only be used in laboratory settings. In 2011, the National HIV Testing Policy underwent significant review and established a framework for the introduction of PoCT in Australia proposing standards around training, settings and quality assurance. This presentation will outline the current situation of point of care tests for HIV in Australia and highlight some issues around their introduction and regulation in the broad non-laboratory based context. Data will be presented on the performance of participants in the Royal College of Pathologists of Australasia (RCPA) external quality assurance program (QAP) for HIV PoCT, highlighting issues with quality in regional laboratories where PoCT are widely used.

Frequency of human immunodeficiency virus infection among students of tertiary and secondary institutions in an endemic state.

Background:Students are pivotal to manpower development and technological advancement of any nation. Nigerian nation was recently ranked third human immunodeficiency virus (HIV) most endemic nation in the worldAim:The study was designed to determine the frequency of HIV infection among Nigerian tertiary and secondary institution students.Materials and Methods:A HIV screening test was conducted on 1,978 apparently healthy students composed of 981 males and 997 females aged 11–35 years, randomly selected from some Nigerian tertiary and secondary institutionsResults:Overall, the sero-prevalence rate of 13.7% was recorded consisting 9.9% in the tertiary and 3.8% in secondary institutions. The distribution of the infection showed no significant difference by age (χ2=1.07, P>0.05) and by gender (χ2=0.85, P>0.05). Also, the prevalence had no significant association with the settlement of students (χ2=0.96, P>0.05) and the status of educational institutions (χ2=1.42, P>0.05).Conclusion:The findings indicate a high HIV prevalence rate among students in this part of the globe. General behavioral changes about sex among the students are suggested.

Evaluation of Four Qualitative Third-Generation HIV Antibody Assays and the Fourth-Generation Abbott HIV Ag/Ab Combo Test

Objective: Compare the agreement between four third-generation rapid or automated human immunodeficiency virus (HIV) tests vs the fourth-generation Abbott ARCHITECT HIV Ag/Ab Combo assay (Combo Test) (Abbott Laboratories, Abbott Park, IL) in 7 clinical laboratories located throughout the Dallas-Fort Worth, TX, metroplex area. Methods: We tested a total of 220 specimens from the general population of patients being screened for HIV antibody status, including Western blot (WB) and HIV-1 RNA viral load by NAAT in patients with initially positive HIV screening tests. We performed a method precision study of the Combo Test and evaluated the agreement between the 4 comparative methods (CMs) against the Combo Test method (TM) using a 2 × 2 contingency table to determine values for positive percent agreement (PPA), negative percent agreement (NPA), and overall percent agreement (OPA) according to the guideline (EP12-A2) for the evaluation of qualitative assays published by the Clinical Laboratory Standards Institute (CLSI). Results: The Combo Test yielded consistent (reproducible) results when the HIV antibody (or p24 antigen) concentration was 20% away or more from C50. In addition, values for PPA, NPA, and OPA for CM vs TM results were all 100%, or not significantly different from 100%. Conclusion: The high detection rate of the Combo Test, when coupled with its high diagnostic sensitivity and specificity, rapid TAT (<30 minutes) of test results using a fully automated instrument (ARCHITECT), and excellent agreement with HIV-1/2 antibody results by several commercially available HIV-1/2 screening tests and with WB and NAAT results, indicate that the Abbott HIV-1/2 Ab/Ag Test is a useful screening test in the identification of HIV-infected individuals. * HIV : human immunodeficiency virus CM : comparative method TM : test method PPA : positive percent agreement NPA : negative percent agreement OPA : overall percent agreement CLSI : Clinical Laboratory Standards Institute AIDS : acquired immunodeficiency syndrome UNAIDS : United Nations Programme on HIV/acquired immunodeficiency syndrome CDC : Centers for Disease Control gag : group-specific antigen EIAs : enzyme immunoassays CAP : College of American Pathologists WB : Western blot NAAT : nucleic acid amplification test AMH : Arlington Memorial Hospital BAS : Baylor All-Saints BUMC : Baylor University Medical Center THD : Texas Health Presbyterian Hospital, Dallas THFW : Texas Health Harris Methodist Hospital THP : Texas Health Presbyterian Hospital THSW : Texas Health Harris Methodist Hospital Southwest R : reactive NR : nonreactive EDTA : ethylenediaminetetraacetic acid LL : lower limits UP : upper limits S/CO : signal-to-cutoff %pos : percentage of positive %neg : percentage of negative FP : false positive FN : false negative POC : point-of-care TAT : turnaround time

Nontargeted Rapid Human Immunodeficiency Virus Screening Provided by Dedicated Personnel Does Not Adversely Affect Emergency Department Length of Stay

In September 2006, the Centers for Disease Control and Prevention (CDC) recommended routine (nontargeted) human immunodeficiency virus (HIV) screening for all patients in the emergency department (ED). Although the American College of Emergency Physicians has endorsed these recommendations, the College expressed concern that that their adoption may lead to an increase in the length of stay (LOS) for ED patients. This study therefore analyzed the effect of nontargeted HIV screening on LOS in a cohort of ED patients. The analysis was performed in an urban, Level I trauma center that offers nontargeted opt-out HIV screening using dedicated HIV screeners. The LOS of all discharged patients who accepted HIV screening between May 2008 and December 2009 were compared with those of a cohort of patients over the same time period who were offered an ED HIV screening test but declined or were found to be not eligible. Median LOS was compared using the Wilcoxon rank sum test, and a multivariable linear model was used to assess the relationship between the acceptance of HIV testing and ED LOS. Over the 20-month study period, there were 18,577 records of discharged patients who were offered an HIV screening test and for whom there were data about LOS. Of these, 10,286 patients accepted HIV screening, and 8,291 patients declined or were found not to be eligible. Individuals who accepted the HIV test had an LOS that was 2% longer compared to those who did not accept the test (regression beta coefficient = 1.02, 95% confidence interval [CI] = 1.00 to 1.03, p = 0.04). Human immunodeficiency virus screening using an additional staff model has no clinically significant effect on the overall LOS for discharged patients.

Analysis of cases of rape as seen at the Jos University Teaching Hospital, Jos, North Central Nigeria

Women are at a higher risk of being sexually harassed. There is a need to document the clinical findings of this crime and its outcome in order to improve the quality of care the victims receive. Case notes of patients who presented with alleged rape at Jos University Teaching Hospital between January 2001 and December 2003 were retrieved and analyzed. During the study period, 2,135 patients were seen in the Gynaecological Emergency Unit. A total of 120 were for alleged rape, representing 5.6% of the total cases seen. However, only 105 case notes were available for analysis. Of these, 63.8% of the alleged rapes were in children, with the infantile age group accounting for 26.7%. 36.2% of the victims had experienced some form of sexual exposure prior to the rape. A previous relationship with the rapist was established in 77.4% of the cases. Most cases delayed in presenting to hospital. Thirty six percent of the cases did not have a human immunodeficiency virus screening test done. Candida albicans (13.3%) accounted for most of the infectious agents. Emergency contraception was administered to the victims when indicated. Women under 16 years of age were at an increased risk of being raped, possibly because they are defenseless and vulnerable. Three quarters (3/4) of the assailants had some form of relationship with the victims, which may account for the delays in reporting. Children and young adolescents were more at risk than adults to be raped.

Evaluation of the Performance Characteristics of 6 Rapid HIV Antibody Tests

Since 2002, the US Food and Drug Administration has approved 6 rapid human immunodeficiency virus (HIV) tests for use in the United States. To date, there has been no direct comparison of the performance of all 6 tests. Persons known to be HIV-infected and persons who sought HIV testing at 2 clinical sites in Los Angeles, California, were recruited for evaluation of 6 rapid HIV tests with whole blood, oral fluid, serum, and plasma specimens. Sensitivity and specificity of the rapid tests were compared with viral lysate and immunoglobulin (Ig) M-sensitive peptide HIV enzyme immunoassays (EIAs). A total of 6282 specimens were tested. Sensitivity was >95% and specificity was >99% for all rapid tests. Compared with the IgM-sensitive EIA, rapid tests gave false-negative results with an additional 2-5 specimens. All rapid tests had statistically equivalent performance characteristics, based on overlapping confidence intervals for sensitivity and specificity, compared with either conventional EIA. All 6 rapid tests have high sensitivity and specificity, compared with that of conventional EIAs. Because performance was similar for all tests and specimen types, other characteristics, such as convenience, time to result, shelf life, and cost will likely be determining factors for selection of a rapid HIV screening test for a specific application.

HIV type 2 in New York City, 2000-2008.

Antibody cross-reactivity complicates differential diagnosis of human immunodeficiency virus (HIV) type 2 (HIV-2) using standard serologic screening and confirmatory tests for HIV. HIV type 1 (HIV-1) viral load testing does not detect HIV-2. Although HIV-2 is, in general, less pathogenic than HIV-1, it can lead to immunosuppression and clinical AIDS, and there are important differences in the selection of antiretroviral therapy for HIV-2-related immunosuppression that make it imperative to differentiate between the 2 viruses. The New York City Department of Health (New York, NY) seeks to facilitate accurate diagnosis and surveillance of HIV-2 infection in the city. We used routine HIV-1-2+O screening and a comprehensive algorithm to differentiate between HIV-1 and HIV-2 infection, universal HIV-related laboratory test reporting, population-based surveillance of HIV infection, and active communication with clinicians. Between 1 June 2000 and 31 December 2008, 62 persons received a diagnosis of confirmed or probable HIV-2 infection. The majority (60 [96.8%] of 62 individuals) were foreign-born (96.7% were born in Africa) and of black race/ethnicity (93.5%). At the time of initial diagnosis, 17.7% of patients with HIV-2 infection had AIDS. Forty (64.5%) of the patients received an initial diagnosis of HIV-1 infection. Among these patients, the median lag between initial diagnosis of HIV-1 infection and identification of HIV-2 as the infecting organism was 487.5 days. HIV-2 should be ruled out in persons presenting for HIV testing who originate in or travel to West Africa and other areas in which HIV-2 is endemic, particularly those who have negative or indeterminate results on HIV-1 Western blot testing or have atypical banding patterns and/or present with clinical signs of HIV infection or unexplained immunosuppression.