Human Immunodeficiency Virus Western Blot Research Articles

Characterization of Rare Spontaneous Human Immunodeficiency Virus Viral Controllers Attending a National United Kingdom Clinical Service Using a Combination of Serology and Molecular Diagnostic Assays.

We report outcomes and novel characterization of a unique cohort of 42 individuals with persistently indeterminate human immunodeficiency virus (HIV) status, the majority of whom are HIV viral controllers. Eligible individuals had indeterminate or positive HIV serology, but persistently undetectable HIV ribonucleic acid (RNA) by commercial assays and were not taking antiretroviral therapy (ART). Routine investigations included HIV Western blot, HIV viral load, qualitative HIV-1 deoxyribonucleic acid (DNA), coinfection screen, and T-cell quantification. Research assays included T-cell activation, ART measurement, single-copy assays detecting HIV-1 RNA and DNA, and plasma cytokine quantification. Human immunodeficiency virus seropositivity was defined as ≥3 bands on Western blot; molecular positivity was defined as detection of HIV RNA or DNA. Human immunodeficiency virus infection was excluded in 10 of 42 referrals, remained unconfirmed in 2 of 42, and was confirmed in 30 of 42, who were identified as HIV elite controllers (ECs), normal CD4 T-cell counts (median 820/mL, range 805-1336), and normal CD4/CD8 ratio (median 1.8, range 1.2-1.9). Elite controllers had a median duration of elite control of 6 years (interquartile range = 4-14). Antiretroviral therapy was undetected in all 23 subjects tested. Two distinct categories of ECs were identified: molecular positive (n = 20) and molecular negative (n = 10). Human immunodeficiency virus status was resolved for 95% of referrals with the majority diagnosed as EC. The clinical significance of the 2 molecular categories among ECs requires further investigation.

Performance of the Enzyme Linked Fluorescent Assay in Diagnosis of HIV Infection; Comparative Evaluation with other Methods.

Our study aimed to investigate the role of the enzyme linked fluorescent assay (ELFA) method in the diagnosis of Human Immunodeficiency Virus (HIV) infection by comparing it with enzyme-linked immunosorbent assay (ELISA) and chemiluminescent microplate immunoassay (CMIA) methods and its role in the HIV diagnostic algorithm and to update the recommended algorithm for HIV testing. We evaluated 101 HIV-reactive and 101 HIV-negative specimens. All samples were studied with the methods of anti HIV1/2 test micro-ELISA, ELFA, and CMIA. At the same time, HIV RNA PCR and western blot (WB)/rapid immunochromatographic test (RICT) were also studied with the same samples. All HIV RNA and WB positive samples (n = 101) were positive with micro-ELISA, CMIA and ELFA. Twenty-five negative samples of HIV RNA and WB were positive with micro-ELISA and CMIA, while just 6 samples were positive with ELFA. When all samples were evaluated together, the false positivity rate of the ELFA method was found to be 5.9%, and the false positivity rates of the micro-ELISA and CMIA methods were determined to be 31.7% and 30.7%, respectively. It was determined that there is a high level of agreement between the ELFA method and confirmation tests. It was thought that it might take place in the preconfirmation stage. As can be seen from the results obtained, the false positive rate by ELFA method was found to be about five times lower than that of micro-ELISA and CMIA methods. Considering that antigen (p24) and antibody positivity can be given separately with this aspect, it can be considered that there is a confirmation place in HIV diagnosis algorithm.

Comparative study on HIV rapid detection of saliva and blood in MSM of Shenzhen

Objective To compare the results of HIV rapid detection reagent in saliva and blood in MSM in Shenzhen, and we clarify the role of saliva rapid detection in HIV screening in this population. Methods The exudate in saliva and blood samples of the same subjects in 393 MSM in Shenzhen were collected, and the HIV immunoblotting kit was used as the reference reagent to confirm the consistency of salivary antibody detection kit (colloidal gold method) and human immunodeficiency virus (HIV) type 1+2 antibody detection kit (colloidal selenium method). Results Totally 393 MSM were recruited. The true positive, false positive, true negative, false negative cases for saliva test reagents were 120, 0, 272, 1, respectively. Those for blood test reagents were 121, 3, 269, 0, respectively. The detection results of the HIV western blot kit were taken as the gold standard to compare and analyze the detection results of saliva and blood detection reagent. The sensitivity, specificity, false-positive rate, false-negative rate and accuracy of exudate in saliva test reagents were 99.2%, 100.0%, 0.0%, 0.8% and 99.8%, respectively. Those of blood test reagents were 100.0%, 98.9%, 1.10%, 0.0% and 99.2%, respectively. Kappa test analysis showed that the results of rapid saliva and blood test were consistent with HIV diagnosis, and the Kappa values were 0.994 and 0.982, respectively. McNemar paired chi-square test was used to analyze the results of saliva and blood rapid test, and the difference was not statistically significant ( P =0.125). Conclusion Saliva and blood screening results have a good consistency, exudate in saliva detection is noninvasive and fast, this method is worth promoting for HIV self-screening in high risk population. 摘要：目的 分析深圳市男男性行为者(MSM)中唾液和血液HIV快速检测试剂结果, 探讨唾液快速检测法在MSM 人群HIV筛査的作用。 方法 同时采集深圳市393名MSM人群的唾液和血液样本 , 使用HIV免疫印迹试剂盒作为参 考试剂, 比较唾液抗体检测试剂盒(胶体金法)和人类免疫缺陷病毒(HIV) 1+2型抗体检测试剂盒(胶体砸法)两种快速 检测试剂结果的符合性。 结果 在393份MSM有效样本中, 唾液检测试剂的真阳性为120例, 假阳性为0例, 真阴性为 272例, 假阴性为1例。血液快速法真阳性为121例, 假阳性为3例, 真阴性为269例, 假阴性为0例。以HIV免疫印迹试 剂盒检测结果为金标准 , 唾液检测试剂的灵敏度为99.2%, 特异度为100.0%, 假阳性率为0.0%, 假阴性率为0.8%, 准确 度为99.8%。血液检测试剂的灵敏度为100.0%,特异度为98.9%, 假阳性率为1.1%, 假阴性率为0.0%, 准确度为 99.2%。Kappa检验分析显示唾液、血液快速检测法与HIV诊断结果存在一致性, Kappa值分别为0.994和0.982; McNemar配对卡方检验分析唾液和血液快速法的检测结果发现二者的差异无统计学意义( P =0.125)。 结论 唾液与血液的 筛査结果具有较好一致性 , 基于唾液检测安全无创、快速, 该方法值得在髙危人群HIV抗体自我筛査中推广使用

Combined Treatment with Tenofovir (C9H14N5O4P), Emtricitabine (C8H10FN3O3S) and Efavirenz (C14H9ClF3NO2) in Multiple Spleen Abscesses with Bacterial and Fungal Etiology in HIV Infected Patients

Patients with human immunodeficiency virus (HIV) infection represent a risk group for developing spleen abscesses. The paper presents a short review and case illustration, describing the characteristics and underling treatment of HIV-infected patients with infectious comorbidities. There are few reports in literature of multiple spleen abscesses with double, microbial and fungal etiology in HIV-infected patients. A 35 years old male patient was referred to the Infectious Diseases Clinic with prolonged fever. In the last 2 years he had worked as a waiter and had multiple unprotected sexual contacts. The physical examination showed: fever, tongue and pharynx with Candida albicans deposits, enlarged cervical, submandibular, axillar, inguinal lymph nodes and splenomegaly. Biological tests including HIV antibodies (Ab) ELISA, CD4, HIV Western blot test, cultures and paraclinical investigations-abdominal ultrasonography and computed tomography were performed. There was a significant inflammatory response, HIV Ab were positive, CD4 cells=17/�L and Western blot HIV test was positive. Abdominal ultrasonography showed: splenomegaly with 3 hypoechogenic round images (13-17mm) at the superior pole, in the hilum and inferior pole. HIV infection stage C3 with oropharyngeal candidiasis and multiple splenic abscesses were diagnosed. After 6 weeks of antibiotic and antifungal therapy total splenectomy was performed. The cultures from splenic abscess contents revealed Acinetobacter baumannii and Cryptococcus neoformans. Under appropriate antibiotic and antifungal treatment, the postoperatory evolution was favorable.

Performance of the HIV Blot 2.2, INNO-LIA HIV I/II Score, and Geenius HIV 1/2 Confirmatory Assay for use in HIV confirmation.

In view of recent revised recommendations for human immunodeficiency virus (HIV) confirmatory testing, the performance of 3 HIV confirmatory assays was compared. Using the HIV Blot 2.2 (MP-WB), the INNO-LIA HIV I/II Score (INNO), and the Geenius HIV 1/2 Confirmatory Assay (Geenius), we tested 199 HIV-1 positive, 161 HIV negative, 65 HIV western blot indeterminate, 26 HIV seroconversion, 34 early HIV infection and 4 HIV-2 positive archived specimens. We show that all 3 assays had comparable test sensitivity in the detection of HIV-1 positive cases. However, less non-specific reactivity was observed with the INNO and Geenius assays, where both of them were able to resolve MP-WB indeterminate cases. When early HIV cases were considered, INNO and Geenius were more likely to confirm an early-stage infection as positive. Nevertheless, overall poor sensitivity (25.5% - 44.7%) of these assays for the detection of early cases was observed, likely because these cases had very low or non-detectable levels of HIV antibodies. Hence, further testing by a nucleic acid test or a p24 antigen test of specimens reactive on screening with a fourth generation Ag/Ab assay that are negative on confirmatory testing for HIV-specific antibody, may be useful. In conclusion, INNO and Geenius had comparable test performance, although the ease of use and shorter assay time for Geenius may make it the preferred choice for laboratories. In that regard, of note is our observation of non-specific reactivity of lipaemic specimens to the HIV-2 gp140 band in the Geenius assay, which should prompt caution when interpreting results of such specimens.

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.

Multisite Laboratory Evaluation of a Dual Human Immunodeficiency Virus (HIV)/Syphilis Point-of-Care Rapid Test for Simultaneous Detection of HIV and Syphilis Infection.

Background. Recently, test developers have created rapid point-of-care tests that can simultaneously detect multiple infections within the same specimen using a single device. The SD BIOLINE Duo HIV/Syphilis rapid point-of-care test uses a solid-phase immunochromatographic assay to detect immunoglobulin (Ig)G, IgM, and IgA antibodies to human immunodeficiency virus (HIV)-specific antigens (HIV-1 gp41, sub O, HIV-2 gp36) and recombinant Treponema pallidum antigen (17 kDa) in human serum. This study was a multisite laboratory-based evaluation of the performance of SD BIOLINE HIV/Syphilis Duo test using previously characterized sera in 6 countries.Methods. Laboratories in Ghana, Mexico, Laos, Togo, Kenya, and Myanmar participated in the evaluation during 2012–2013. Each site characterized sera using T pallidum particle agglutination assay or T pallidum hemagglutination assay and HIV enzyme immunoassay, Western blot, and/or HIV antibody rapid tests. Those gold standard test results were compared with SD BIOLINE Duo test results. We calculated the sensitivity and specificity of test performance and used the exact binomial method to calculate 95% confidence intervals (CIs).Results. The sensitivity and specificity for the HIV antibody test component (n = 2336) were estimated at 99.91% (95% CI, 99.51% and 100%) and 99.67% (95% CI, 99.16% and 99.91%), respectively. For the T pallidum test component (n = 2059), the sensitivity and specificity were estimated at 99.67% (95% CI, 98.82% and 99.96%) and 99.72% (95% CI, 99.29% and 99.92%), respectively.Conclusions. The sensitivity and specificity of the SD BIOLINE HIV/Syphilis Duo test were consistently high across sera specimens from 6 countries around the world. Dual rapid tests should be considered for improved HIV and syphilis screening coverage.

P1.044 A Cross-Sectional Study Comparing Serum Vitamin D Levels in Human Immunodeficiency Virus-Infected and -Uninfected Individuals

BackgroundSince the evolution of human immunodeficiency virus (HIV) infection, every effort has been made to increase the survival and quality of life of the infected patients. In this regard, metabolic/nutritional...

A Case of Neurosyphilis Presenting as a Stroke in a Patient with Human Immunodeficiency Virus Infection

후천성 면역 결핍증 환자에서 ì‹ ê²½ë§¤ë ì´ ë°œìƒí• í™•ë¥ ì€ ì •ìƒì¸ì— 비해 높으며, 임상 증상은 다양하게 ë‚˜íƒ€ë‚ ìˆ˜ 있다. 후천성 면역 결핍증을 가진 42세 남자가 급성 뇌경색 형태의 ì‹ ê²½ ë§¤ë ì¦ìƒì„ 보였으며 이에 대해 항 혈소판 치료, í•­ìƒì œ 치료, 항 바이러스 치료를 함께 ì‹œí–‰í•˜ì˜€ê³ , ì„±ê³µì ìœ¼ë¡œ 치료하였기에 증례로 ë³´ê³ í•˜ëŠ” 바이다. 중심 단어: ì‹ ê²½ë§¤ë ; 사람면역 결핍 바이러스; 뇌경색

Positive HIV ELISA test, autoimmune hemolytic anemia, and generalized lymphadenopathy: A unifying diagnosis

Positive HIV ELISA test, autoimmune hemolytic anemia, and generalized lymphadenopathy: A unifying diagnosis

Detection of Hepatitis C virus and Human immunodeficiency virus in expatriates in Saudi Arabia by antigen-antibody combination assays

The simultaneous detection of antigen and antibody was originally described for the early detection of the human immunodeficiency virus (HIV). The same approach was applied to detect the hepatitis C virus (HCV). The aim of this work was to use the antigen and antibody combination assay for the detection of HCV and HIV infections in expatriates in Eastern Saudi Arabia. The study group (N = 875) included expatriate workers of both sexes who were undergoing mandatory pre-employment testing. Detection of anti-HCV antibodies, HCV core antigen, HCV viral RNA, HIV antigens and antibodies was conducted using commercially available kits. Of the 875 samples that were screened for HCV-specific antibodies, four (0.46%) tested positive (two from Pakistan, one from India, and one from the Philippines) and two (0.23%) were equivocal (one from Egypt and one from Nepal). All four samples that were positive for HCV-specific antibodies also tested positive using HCV RNA assay and the HCV antigen-antibody combination assay. The two samples that were equivocal tested positive using the HCV RNA assay and the HCV antigen-antibody combination assay. Of the 875 samples that were tested for HIV antibodies, only one (0.11%) sample gave repeatedly positive results. The same sample also tested repeatedly positive using the HIV combination assay. These results were subsequently confirmed by HIV western blot assay. Our study indicates that the addition of antigen detection to the screening of HCV and HIV may lower the risk of transmission of these viruses in the host country and contribute to the overall control of HCV and HIV in Saudi Arabia.

Seroepidemiologic Study of Hepatitis B Virus, Hepatitis C Virus, Human Immunodeficiency Virus and Syphilis Infections in Iranian Blood Donors

To determine the frequency of hepatitis B, hepatitis C, Human Immunodeficiency Virus (HIV) and syphilis infections in Iranian blood donors. The prevalence of serological markers of hepatitis B, hepatitis C, HIV and syphilis infections were evaluated in 318029 consecutive volunteer blood donors attending to Tehran blood transfusion service from March 2005 to March 2006. Those positive for hepatitis B surface antigen, anti-HCV, anti-HIV1/2 and VDRL (venereal disease research laboratory) reactivity were analyzed with a second independent HBsAg enzyme immunoassay (EIA) and neutralization assay; an additional independent anti-HCV EIA and HCV-RIBA assay; second independent anti-HIV1/2 test, HIV western blot and fluorescent Treponemal Antibody Absorbed (FTA-ABS), respectively. In 318029 participants, prevalence of positive HBsAg, HCV RNA, HIV western blot and FTA-ABS was 1684 (0.487%), 323 (0.093%), 11 (0.003%) and 19 (0.005%), respectively. In 1014 subjects randomly selected from these 318029 participants, besides standard interview, physical exam and routine serologic tests; anthropometric and biochemical were studies. In this selected group frequency of HBsAg was 3 (0.29, 95% CI: 0-0.64%); frequency of anti-HCV was 21 (2.07%), but it was (0.09%, 95% CI: 0-0.30%) by confirmatory HCV RNA test; frequency of HIV-Abl, 2 was 8 (0.78%), but it was 2 (0.19%, 95% CI: 0-0.48%) by confirmatory test; frequency of RPR was 0 (0%, 95% CI: 0-0.30%). Despite excluding subjects with high-risk behaviors by standard interview and physical examination, still a few asymptomatic hepatitis B, hepatitis C, HIV-infected subjects existed among volunteer blood donors with demographic and biochemical findings similar to non-infected ones.

Different Positive Predictive Values of Commercially Available Human Immunodeficiency Virus Enzyme-Linked Immunosorbent Assays

We report our findings concerning the positive predictive values (PPVs) of commercially available human immunodeficiency virus (HIV) antibody tests in an evaluation of HIV prevalence in Peru. The specificity of enzyme-linked immunosorbent assays (ELISAs) varies according to multiple factors, including antigen characteristics, avidity of serum antibodies, patient comorbidities, and specimen processing (2-4). Despite high test specificity, our study found significant variability in the PPVs of several commercially available HIV ELISA kits. As part of a large HIV/STD Collaborative Prevention Trial sponsored by the U.S. National Institute of Mental Health (NIMH) and conducted by the NIMH Collaborative HIV/STD Prevention Trial Group, two population-based surveys were performed to evaluate the prevalence of HIV type 1 (HIV-1) infection and sexually transmitted diseases (STDs) in Lima, Peru, and in northern Peru in 2001 and 2003. While the 2001 study (survey 1) evaluated the general population, the 2003 study (survey 2) examined groups at higher risk for infection. Sera were screened by ELISA for antibodies to HIV-1 using Vironostika (bioMerieux, Inc., Durham, NC) and for antibodies to HIV-1/HIV-2 using Genscreen Plus Ag-Ab (Bio-Rad Laboratories, Marnes la Coquette, France) or Genetic Systems (Bio-Rad Laboratories, Hercules, CA). We confirmed ELISA-positive samples by HIV-1 Western blotting using New Lav Blot I (Bio-Rad France) or Genetic Systems (Bio-Rad USA). Due to several reported “indeterminate” results in survey 1 using New Lav Blot I, these samples were retested with Genetic Systems Western blot kit. ELISA-positive samples in survey 2 were confirmed by using only the Genetic Systems Western blot kit. Results from the Genetic Systems assay were used as the gold standard for determining PPVs in subsequent-calculations. The absence of reported cases of HIV-2 in Peru to date obviated the need for HIV-2-specific Western blot analysis. All samples were processed at the U.S. Naval Medical Research Center Detachment (Lima, Peru) by skilled technicians and were subject to rigorous quality control standards. All of the tests used were reported to have a specificity at or close to 99% in manufacturers' trials and in surveys of available tests published by the World Health Organization and the Centers for Disease Control and Prevention (1, 5). The PPV of the Vironostika assay, however, was significantly higher than the PPVs of the Genscreen test in survey 1 (100.0% versus 62.8% [P = 0.001]) and the Genetic Systems test in survey 2 (98.3% versus 85.2% [P = 0.009]) (Table ​(Table1).1). The PPV of the Vironostika assay was statistically comparable in the two surveys despite the lower prevalence of disease in the general population tested in survey 1 (P = 1.000). TABLE 1. Test performance of HIV ELISA and Western blot assays in population-based surveys in Peru in 2000 to 2003 Despite optimal test specificity, our study illustrates the drastic variation in the PPVs of these assays when applied to large-scale HIV testing. Seemingly minor differences in test specificity are amplified when used in population-based studies, even in communities with what is considered a relatively high prevalence of disease. These results emphasize the value of selecting an ELISA according to the characteristics of the testing population and the critical importance of confirming any positive ELISA results by Western blot analysis. (This work was originally presented at the Infectious Disease Society of America 2004 Annual Meeting, Boston, Mass., 30 September to 3 October 2004 [R. Castillo, R. Meza, S. Leon, J. Pajuelo, C. F. Caceres, J. D. Klausner, T. J. Coates, and F. R. Jones, Infect. Dis. Soc. Am. 2004 Annu. Meet. Program Abstr. Book, abstr. 826, 2004].)

Prevalence of indeterminate human immunodeficiency virus western blot results in pregnant women attended at a public hospital in Presidente Prudente, Brazil

The AIDS epidemic is spreading rapidly among women worldwide, offering increasing opportunities for vertical transmission of HIV. In Brazil, the prevalence of HIV infection among pregnant women is less than 1%. Therefore, the positive predictive value of an HIV EIA test tends to be lower than the more frequent indeterminate Western blot result. Pregnant women receiving antenatal care, from 2000 to 2004, at a public secondary hospital in the city of Presidente Prudente, São Paulo, Brazil, were systematically screened for HIV by means of two distinct EIA tests, in order to determine the prevalence of indeterminate Western blot results among pregnant women showing discordance in both HIV EIA tests and indirect immunofluorescence assay. Confirmatory indirect immunofluorescence was performed on material for all women with positive results in both EIA tests. Whenever there were positive results in EIA and IIA, the applicant was retested by the initial screening assay. Only those not showing concordance in results in EIA and IAA had a Western blot performed. The viral load was measured in pregnant women with positive or indeterminate Western blot results. Out of 9,786 sera, 105 (1.0%) were positive in the two HIV EIA screening tests, confirmed by indirect immunofluorescence. Among these women, Western blot was interpreted as indeterminate in 11 (0.1%) cases and their viral load was <50 copies/mL. We found a prevalence of 0.1% HIV indeterminate Western blots in pregnant women from Presidente Prudente and the surrounding region; none of these pregnant women had positive HIV viral loads.

Evaluation and Diagnostic Usefulness of Domestic and Imported Enzyme-Linked Immunosorbent Assays for Detection of Human Immunodeficiency Virus Type 1 Antibody in India

Diagnosis of human immunodeficiency virus (HIV) infection is important for patient management and prevention of new infections. The number of test kits available for the detection of HIV antibodies is unprecedented. In order to identify appropriate test kits, we evaluated a variety of commercial kits manufactured abroad as well as in India. The plasma and serum specimens (n=264) were collected from individuals attending the Voluntary Counseling and Testing Centre at the YRG Centre for AIDS and Education. The specimens were used to evaluate six commercially available HIV test kits: Enzaids HIV 1+2, HIV-CheX, Murex HIV-1.2.0, Genscreen HIV 1/2 version 2, Vironostika HIV Uni-Form II Ag/Ab, and CombAids RS Advantage. High sensitivities and specificities (>or=99%) were observed for the Enzaids, Murex, Vironostika, and CombAids assays. HIV-CheX showed the highest number of false-positive and false-negative results. The Genscreen test also gave many false positives. The study indicated that the Enzaids, Murex, and Vironostika enzyme-linked immunosorbent assay kits and the CombAids RS Advantage rapid assay could be used to achieve acceptable results for the detection of HIV antibodies. A combination of two tests is recommended to optimize the efficiency of HIV antibody testing algorithms, especially when evaluation with an HIV Western blot confirmatory test is not possible.

Human Immunodeficiency Virus: The Initial Physician-Patient Encounter

Human Immunodeficiency Virus: The Initial Physician-Patient Encounter

Indeterminate human immunodeficiency virus Western blot profiles in ethiopians with discordant screening-assay results.

The Western blot (WB) assay is the most widely accepted confirmatory assay for the detection of antibodies to human immunodeficiency virus type 1 (HIV-1). However, indeterminate WB reactivity to HIV-1 proteins may occur in individuals who do not appear to be infected with HIV. The profiles of WB reactivity among Ethiopians are hardly known. Here, we describe the profiles of indeterminate WB reactivity in Ethiopians with discordant screening assays. Between 1996 and 2000, a total of 12,124 specimens were tested for HIV-1 antibodies. Overall, 1,437 (11.9%) were positive for HIV-1 antibody. Ninety-one ( approximately 0.8%) gave equivocal results because of discordant results among the various screening assays and indeterminate WB profiles by the American Red Cross (ARC) criteria. Most (30.4%) of these indeterminate WB results were due to p24 reactivity. However, 12 samples (13.2%) displayed reactivity to p24 and gp41 or to p24 and gp120/160 proteins (positive by Centers for Disease Control and Prevention [CDC] criteria). Only two samples (2.2%) were reactive to both env glycoproteins gp41 and gp120/160 (positive by the World Health Organization [WHO] criteria). Of 31 WB assays initially indeterminate by the ARC criteria and with follow-up samples, 29 (93.5%) became negative when retested subsequently while 2 (6.5%) remained indeterminate for more than a year and were thus considered negative. Using CDC and WHO criteria, 6 (19.4%) and 2 (6.5%), respectively, of these WB assays would have been considered falsely positive. In addition, 17 indeterminate samples were negative when assessed by a nucleic acid-based amplification assay for HIV-1 viremia. In general, there was 97.8% concordance between the ARC and WHO criteria and 85.7% concordance between the ARC and CDC criteria for an indeterminate WB result. The ARC criteria best met the specified objectives for diagnosis in our setting.

HIV Type 1 Subtype C in Addis Ababa, Ethiopia

HIV-1 variants in different geographic regions have been phylogenetically classified into the genetic subtypes A-I and O on the basis of sequence differences in the V3 regions of their gp120 envelope genes. The existence of all HIV-1 subtypes except subtype I has been confirmed in Africa. This paper describes the distribution of HIV-1 subtypes in Ethiopia. The first Ethiopian AIDS case was reported in 1986 and the AIDS epidemic has now become a rapidly growing problem in Addis Ababa the capital city. HIV-1 seroprevalence in the city is estimated to be 10-27% among pregnant women 47-59% among prostitutes and 7% among blood donors. Preliminary sequence data on a limited number of samples indicated the presence of subtype C in Addis Ababa in 1988. 94 sera collected from prostitutes pregnant women and blood donors during 1989-95 were analyzed to assess the distribution of HIV-1 subtypes in Addis Ababa. HIV-1 subtype C was identified in 93 of 94 cases. One case of subtype A virus was identified. Subtype C was also highly abundant also before the 1995 sera collection. Finally the authors discuss how the Ethiopian subtype C sequences differ slightly from the consensus C sequence.

Western blot banding patterns of HIV rapid progressors in the U.S. Navy Seropositive Cohort: Implications for vaccine development

Although human immunodeficiency virus (HIV) infection is progressive, the rate of decline in CD4 + lymphocyte counts varies. The role of immune system components in limiting HIV infection has yet to be defined, but a previous report on the U.S. Navy HIV Seropositive Cohort reported that strong reactivity in the anti-p55 (core precursor), p24 (core) and p53 (reverse transcriptase) Western blot bands was associated with higher CD4+ lymphocyte counts at the first clinical evaluation for HIV. The previous report examined the cross-sectional association between Western blot banding patterns and initial CD4+ lymphocyte counts. This report examines the association between these banding patterns in individuals who progressed rapidly as compared with patterns of patients who did not, based on their trends in repeated CD4+ lymphocyte counts as a marker of progression. Rapid and slower progressors were identified from a cohort of 3414 Navy and Marine Corps personnel who had a first positive HIV Western blot during 1986–1991. For purposes of this study, rapid progressors were defined as individuals whose CD4+ lymphocyte counts declined to < 500 cells/mm 3 within 1 year of seroconversion. A total of 325 individuals met these criteria. A comparison group of 63 slower progressors also was identified; this group consisted of those whose CD4+ lymphocyte counts remained at ⩾ 500 cells/mm 3 for a minimum of 5 years of follow-up after their first positive Western blot. Rapid processors were slightly younger than slower progressors and were more likely to be never married but did not differ significantly from slower progressors in race or sex. Rapid progressors had weaker reactivity in the anti-p55 core precursor ( P < 0.0001), p15 core ( P < 0.01), gp41 transmembrane ( P < 0.01) and p31 endonuclease ( P < 0.05) bands on the Western blot. The odds ratio for rapid progressor status associated with weak or absent reactivity was 7.8 in the anti-p55 band and ranged from 2.0 to 3.2 in the anti-p31, p15, and gp41 bands. These associations remained significant after adjustment for age, race, and sex. The p55 association persisted in repeated Western blots during routine clinical evaluation during a period of 5 years after the first positive Western blot. It was concluded that several possible explanations may account for the weaker reactivity of rapid progressors: (i) weak anti-p55 reactivity might have been a marker of early immune system damage; (ii) high concentrations of p55 or related proteins in the serum may have bound the available anti-p55 antibodies in rapid progressors, making them difficult to identify on the Western blot; or (iii) lack of anti-p55, p15, gp41, or p31 reactivity might have allowed more rapid progression.

Lack of association of human immunodeficiency virus seroconversion with visits to foreign ports in US Navy personnel

<h3>Background:</h3> The US Navy visits ports on all continents and many islands of the world, many of which are reported to have a high endemicity of human immunodeficiency virus (HIV) infection. The objective of this study was to determine whether visits to foreign ports by active-duty navy personnel were associated with increased risk of HIV infection. <h3>Methods:</h3> The Naval Health Research Center in San Diego, Calif, maintains records of all HIV enzyme-linked immunosorbent assay and Western blot tests given in the navy. This information, along with career histories and ship movement data, was used in a nested case-control design to examine the relationship between visits to the 100 foreign ports most frequently visited by the navy and risk of HIV seroconversion. All visits to a port and total time in each port during the study period were examined. A total of 813 seroconverters were matched to 6993 seronegative active-duty controls by age, race, sex, occupational group, home port, and year of test. <h3>Results:</h3> Estimated relative risks of seroconversion associated with visits to foreign ports showed no statistically significant excess risk of HIV infection for navy personnel after visits to any foreign port. <h3>Conclusions:</h3> These results do not imply that an individual's risk of acquisition of HIV would be less in a foreign port if the individual engaged in high-risk activity there. Rather, they imply that despite the mobility of the US Navy and the large variation in HIV seroprevalence rates throughout the world, navy personnel generally do not appear to be acquiring HIV infections abroad. (Arch Intern Med. 1993;153:2685-2691)