HIV Antibody Screening Research Articles

Epidemiological and pharmacoeconomic aspects of HIV infection in military

The goals of the research are to determine the latent morbidity and financial losses of the Russian Ministry of Defense due to the dismissal of service members with HIV infection at symptomatic stages; to establish the supposed clinical and pharmacoeconomic effectiveness of the early detection and treatment of service members.The materials compile 379 case histories of patients of the only specialized department for HIV-positive military personnel in the Armed Forces for 2017–2019, as well as various reporting forms. The study uses the following methods for the analysis: Markov chains are employed to calculate QALYs (Quality Adjusted Life Years), “cost-effectiveness”, and “willingness to pay”. The research compares two competitive models: “Current Situation” - without the introduction of algorithms for early detection and treatment of HIV infection, and “Prognosis” - with the introduction of these algorithms.The following results are obtained: implementing a mandatory triennial screening for HIV-antibodies among military personnel allows to raise the detection of HIV-positive military personnel in the early stages of the disease by 55%. At the same time, early administered antiretroviral therapy prevents the progression of HIV infection, while the number of military personnel who have reached symptomatic stages of HIV infection and the number of deaths decreases by 35,6% and 80,2% (six-fold), respectively. The economic effectiveness of these measures includes a reduced cost of treatment and an increased length of military service. The sensitivity analysis of the method shows that the proposed measures remain pharmacoeconomically highly effective with a wide variability of the initial data.Conclusion. The results of the study demonstrate that a significant improvement of the epidemiological situation in the field of HIV infection in the Armed Forces is achievable at very low economic costs. With the full implementation of the proposed measures, the cohort of military personnel of the Armed Forces is able to achieve the World Health Organization’s “90-90-90”criteria of in 3–5 years.

HIV antibody screening and ways to improve it to address the problem of containing the spread of HIV infection

The purpose of the study is to determine the current trends in the development of the HIV epidemic process for individual subjects of the Ural Federal district (UFD) and the possibility of corrective measures to update the practice based on the results of screening tests for HIV antibodies.Materials and methods. The study used information from form 4 of the Federal statistical observation «Information on the results of blood tests for HIV antibodies» in the amount of 26,1 million studies for 2009–2018, information from 2,488 questionnaires from two biopsychological studies among commercial sex workers (CSR) and persons in prison. Research result. It was found that, despite the increase in the incidence of HIV infection in the period 2009–2018, the estimated Hurst indicator for the studied time period characterized the long-term dynamics of the incidence as antipersistent. Among MSM and patients with STIs, there is a marked tendency to increase the detection of HIV infection. Among commercial sex workers (CSR) and people in prison, the results of a sentinel bio-behavioral study found high detection of HIV antibodies against the background of risky sexual behavior.According to the indicators of the frequency of detection of antibodies to HIV in screening studies, the territories of the greatest potential risk of HIV infection were determined. In dynamics, there was an increase in the number of studies and the detection of HIV infection among those examined for clinical and epidemic indications (codes 113, 120) and stabilization of the detection of HIV infection among injecting drug users (code 102).Conclusion. In the period 2016–2018, the sexual route of infection became predominant among HIV-infected people. The greatest intensity of HIV infection was observed among such categories of the population covered by official statistics and who are representatives of groups with a predominant HIV infection, such as MSM and patients with STIs. At the same time, there was a decrease in HIV surveys among these populations with an increase in detection.The results of behavioral studies among DCS and persons in prison demonstrate high detection of HIV antibodies among them, as well as the presence of risky sexual behavior. Screening for HIV infection requires additional optimization.

Evaluation of Serum Interleukin 6, Tumor Necrosis Factor-Alpha, and Interferon-Gamma Levels in Relation to Body Mass Index and Blood Pressure in HIV Seropositive Pregnant Women Coinfected with Malaria.

Malaria and HIV are leading causes of morbidity and mortality, particularly in sub-Saharan Africa. Both diseases are highly endemic and have a wide geographic overlap with severe impact on pregnancy. This was a case-control study designed to evaluate the levels of interleukin -6 (IL-6), tumor necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ) and their relationship with some anthropometric indices such as body mass index (BMI) and blood pressure in HIV-malaria coinfected women attending antenatal clinic at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria. 122 pregnant women and 30 nonpregnant women (control) aged between 18 and 42 years were recruited for the study. Screening of HIV antibodies was done using a national algorithm. Peripheral malaria was determined using rapid detection and the Giemsa stain technique. Cytokines were assayed using the enzyme-linked immunosorbent assay technique. HIV-malaria coinfected pregnant women showed significantly higher levels of IL-6, IFN-γ, TNF-α, and blood pressure with reduced BMI value compared with HIV seronegative pregnant and nonpregnant control participants (p ≤ 0.001, respectively). The findings indicated significant cytokine imbalance which suggests an active inflammatory process and reduced cellular immunity. The increased BMI and blood pressure level observed indicate overweight and possible hypertension which could subsequently lead to preeclampsia and other adverse pregnancy outcomes.

Analysis of the HIV antibody screening results among the preoperative examination patients in Beijing Tongren Hospital from 2008 to 2018

Objective: To understand the HIV antibody screening results among the preoperative examination patients in Beijing Tongren Hospital from 2008 to 2018. Methods: A retrospective analysis of the HIV antibody screening data of thepreoperative examination patients from 2008 to 2018 in Beijing Tongren Hospital was performed with software SPSS19.0. Trend chi-square was used to analyze the positive rate, age, marital status, household registration and so on. Results: Among the 750 013 clinical patients, 428 (0.057%) cases were screened anti-HIV positive and 370(0.049%) cases were confirmed anti-HIV positive when detected with western blotting.Most of the HIV-infectedindividuals were non-Beijing nationality, accounting for 60.27%.Among the 370 HIV-infected patients, there were 334 males (90.27%) and 36 females (9.73%). The age was distributed mainly between 20-40 years old (62.43%), secondly between 40-60 years old (28.65%).361 (97.57%)HIV-infected cases were transmitted by the sex and the MSM men increased from 2008 to 2018 (trend χ²=7.307, P=0.007). There were 22 cases (5.95%) with HBsAg positive, 11 cases (2.97%) with anti-HCV positive. Among the 159 HIV-positive patients (42.97%) companied with syphilis specific antibody positive, there were 64 cases (17.30%) with TRUST tests positive. Additionally, 178 (48.11%) HIV-infected patientsfirst visited doctors because of ocular disease in the hospital; secondly, 71 (19.19%) HIV-infected patientsfirst visited the dermatology. Conclusions: The number of HIV-infected patientsmarkedly increased from 2008 to 2018. The sexual transmission is still the main pathway for HIV infection, particularly homosexual transmission. Moreover, the results indicate that it is necessary to detect HIV antibody for the ocular disease patients.

Possible Impact of Select Trace Mineral Deficiency in HIV Seropositive Pregnant Women with/without Malaria Co-infection in NAUTH, Nnewi, Nigeria

Aims: To evaluate the impact of HIV and malaria on serum Zinc (zn), Selenium (se) and Magnesium (mg) in HIV seropositive pregnant women in Nnewi, Nigeria.
 Study Design: This is a case-control study.
 Place and Duration of Study: Prevention of Mother to Child transmission (PMTCT) of HIV Clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi, (NAUTH), Nigeria, between December, 2017 and April, 2018.
 Methodology: We included 122 consented female participants; 32 HIV seropositive pregnant women with malaria parasitaemia, 30 HIV seropositive pregnant women without malaria parasitaemia, 30 Malaria infected pregnant women, 30 pregnant women without HIV or malaria parasitaemia, aged between 18 and 42 years. Screening for HIV antibodies and malaria parasite was double screened using National algorithm, rapid detection technique (RDT) and Giemsa staining microscopy technique respectively. Micronutrient levels were determined using atomic absorption spectrophotometry (AAS).
 Results: When the mean zn, sel and mg levels were compared between the test and control groups, significant decreases in serum zn (37.34 ± 6.7, 36.70 ± 4.39), sel (29.93 ± 6.02, 28.00 ± 5.04) and mg (2.41 ± 0.46, 2.33 ± 0.14) were observed in HIV seropositive pregnant participants with/without malaria co-infection when compared with their corresponding controls Zn (45.1 ± 7.83, 50.36 ± 8.73); Sel (31.46 ± 6.19, 31.96 ± 6.81); Mg (2.62 ± 0.30) and (P < .05 respectively). Body mass index (BMI) was significantly decreased while diastolic blood pressure (DBP) and systolic blood pressure (SBP) were significantly increased in HIV seropositive pregnant women with malaria compared with their seronegative counterparts (P < .05 respectively).
 Conclusion: The significant loss in BMI with derangement in serum zn, sel and mg levels in HIV seropositive pregnant women with/without malaria co-infection indicates high degree of malnutrition while the increased blood pressure suggests high blood pressure which might predispose the pregnant mothers to pre-eclampsia if not properly managed. Adequate micronutrient supplementation and effective anti malaria agent is strictly advocated in the routine management of HIV infected mothers during pregnancy to reduce the severity of the co-infection and adverse pregnancy complications especially in areas of malaria endemic transmissions.

Analysis of Screening Results of Four Common Infectious Diseases in One Stomatology Hospital

Objective: To understand the status and characteristics of hepatitis B, hepatitis C, syphilis and HIV antibody screening in one dental hospital, and to provide scientific basis for the prevention and treatment of common infectious diseases in dental medical institutions. Methods: Collect all samples of patients screened for hepatitis B, hepatitis C, syphilis and HIV from one stomatological hospital in 2018-2019, and make statistics on the distribution of common infectious diseases among patients in stomatology, such as age, gender, type of treatment, department of treatment, etc. Results: The positive rate of hepatitis B was 2.27%, 39.42% in males and 60.58% in females. It was mainly detected by outpatient department, accounting for 87.5%. The age was concentrated in 30 - 60 years old, accounting for 77.88%. It was mainly distributed in oral and maxillofacial surgery, orthodontics and implant, accounting for 82.69%. The positive rate of hepatitis C was 0.1%, 33.33% in men and 66.67% in women. It was mainly detected by outpatient department, accounting for 83.33%. The age is concentrated in 20 - 50 years old, accounting for 100%. It is mainly distributed in oral and maxillofacial surgery, orthodontics and implant, accounting for 100%. The positive rate of syphilis was 0.18%, 33.33% for men and 66.67% for women. It was mainly detected by outpatient department, accounting for 83.33%. The age is concentrated in 30 - 50 years old, accounting for 100%. It was mainly distributed in oral and maxillofacial surgery, orthodontics and implant, accounting for 83.33%. HIV was not detected. Conclusion: The positive detection rate of common infectious diseases in the stomatological hospitals is generally lower than the average level. It is mainly distributed in the department of implant, oral and maxillofacial surgery and orthodontics. The highest positive detection rate of common infectious diseases is hepatitis B which is 2.27%, and the lowest is HIV which is 0.

Risk factors for stroke occurrence in a low HIV endemic West African country: A case-control study

BackgroundHIV infection is an emerging vascular risk factor associated with stroke occurrence. The weight of evidence from sub-Saharan Africa in support of this has accrued from countries with high HIV prevalence. Our objective was to assess the contribution of HIV sero-positivity to the occurrence and outcomes of stroke in a West African country with low HIV prevalence. MethodsA case-control study design conducted at a tertiary medical center in Ghana involved in the Stroke Investigative Research & Educational Networks (SIREN) epidemiological study. Stroke cases were adults (aged ≥18 years) with CT or MRI confirmed stroke and stroke-free controls were age-matched and recruited from communities in the catchment areas of cases. Standard instruments were used to assess vascular and lifestyle factors and serological screening for HIV antibodies was conducted for all study participants. Stroke patients were followed for in-patient mortality outcomes. Associations between HIV, demographic and vascular risk factors and stroke occurrence and outcomes were assessed using logistic regression analysis. ResultsWe enrolled 540 stroke cases and 540 control subjects with a mean (± SD) age of 60.8 ± 15.5 years (cases) and 60.0 ± 15.5 (controls). Among stroke cases, the frequency of HIV was 12/540 (2.2%, 95% CI: 1.3% - 3.6%) versus 15/540 (2.8%, 95% CI: 1.7% - 4.6%) among stroke-free controls, p = .70. However, the median (IQR) age of Persons Living with HIV (PLWH) with stroke was significantly lower at 46.5 (40–65.3) years versus 61.0 (50–74) years, p = .03 among HIV- stroke patients. Stroke among PLWHA was predominantly hemorrhagic in 7 out of 12 cases and ischemic in 5 of 12 with notable clustering of established factors such as hypertension, (100%), dyslipidemia, 83.3%, central obesity, 50.0%, diabetes mellitus, 33.3%, cardiac diseases, 8.3% in this group. None of the PLWH with stroke were receiving antiretroviral therapy. ConclusionWe found no associations between HIV infection and stroke occurrence among Ghanaians. However a clustering of cardio-metabolic factors in the context of HIV may promote stroke occurrence in younger individuals.

Analysis on influencing factors that leading to nonspecific responses to indeterminate results of HIV antibodies

Objective: To identify the influencing factors that leading to nonspecific responses to indeterminate HIV antibody tests, to provide scientific evidence for the differential diagnosis of HIV infection and control strategy. Methods: A case control study was conducted. The samples of HIV antibody indeterminate in confirmed Western blot (WB) tests, but were negative in HIV nucleic acid tests, were collected as HIV antibody indeterminate group from WB results of HIV confirmatory laboratories of Fujian province in 2015-2016. The general population matched group with HIV antibody screening negative samples and WB negative matched group with WB negative samples were selected as the two compared groups by matching gender and age from HIV antibody screening in Fujian province in the same period. Blood concentrations of hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (HCV) antibody, anti-treponema pallidum (TP) antibody, antinuclear antibody (ANA), anti-human T-cell leukemia virus (HTLV) antibody, and alpha-fetoprotein (AFP) were detected by using enzyme-linked immunosorbent assay (ELISA). χ(2) test and multivariate non-conditional logistic regression analysis were performed to identify the influencing factors that leading to nonspecific responses, to indeterminate HIV antibody tests. Results: A total of 13 WB band patterns were observed in 110 HIV antibody indeterminate samples, in which a single p24 band (58.18%, 64/110), a single gp160 band (17.27%, 19/110) and a single p17 band (7.27%, 8/110) were the three most common patterns. The positive rate of anti-TP antibody was significantly higher in HIV antibody indeterminate samples than general population control group and WB negative control group (10.91%, 12/110 vs. 1.77%, 4/226 and 3.64%, 4/110), compared with two control groups (χ(2)=13.627 and 4.314, P<0.05). The positive rate of AFP was significantly higher in HIV antibody indeterminate samples than general population control group (18.18%, 20/110 vs. 0.44%, 1/226, χ(2)=39.736, P<0.05), the different was not significant compared with WB negative control group (18.18%, 20/110 vs. 23.64%, 26/110, χ(2)=0.990, P>0.05) While no significant differences were found between HIV antibody indeterminate group and two control groups in terms of the positive rates of ANA, HBsAg, anti-HCV antibody or anti-HTLV antibody. Conclusions: The influencing factors that leading to nonspecific responses to indeterminate HIV antibody tests appeared complicate, and the anti-TP antibody positivity might be an influencing factor responsible for nonspecific responses to indeterminate HIV antibody tests.

Experience of a rapid test center for HIV in a public hospital

Background: The implementation of rapid tests for HIV allows to improve the accessibility to the diagnosis and favors the incorporation of the people to the health system. Methods & Materials: A prospective epidemiological study between 01 April and 30 September 2017 of the people studied with quick method of HIV at General Hospital San Roque in La Plata was performed. During the 6-month period, 172 people, 80 women and 92 men between 7 and 72 years of age were studied. In all cases a pre-test interview was conducted and the results were delivered with counseling. Extraction of venous blood was drawn by puncture of digital fingertip lancing. The HIV antibody screening was performed by reactive immunochromatographic strips (Quick Test Determine HIV). People with preliminary positive results were referred to the hospital laboratory for confirmation. We used the diagnostic algorithm recommended by the Ministry of Health of the Nation. ELISA (Architect) and viral load (Roche Cobas ampliprep) were carried out in the Reference Laboratory of the “Tomas Perón” Biological Institute. Results: Data of all people studied in this period by sex and age groups were:Tabled 1April - September 2017 Open table in a new tab Tabled 1Age (years)MenWomen<14115-196820-29382630-39192640-49168>501311TOTAL92 (53.5%)80 (46.5%) Open table in a new tab The level of education reached (in%) of the persons tested was: Complete elementary school 10.30% Incomplete elementary school 5.20% Completed high school 29.00% Incomplete high school 14.00% Complete tertiary school 8.00% Incomplete tertiary school 8.00% Complete university 15.00% Incomplete university 10.30% Conclusion: Of the 172 people tested in the period, 92 (53.5%) were men and 80 (46.5%) women. Education level reached by the tested group in about 80% was high school or higher. Of the total number of people studied, 6 (3.5%) obtained preliminary positive results and had to be confirmed with ELISA and CV for HIV in the laboratory. They were 3 female of 34, 35 and 43 years and 3 males of 21, 24 and 34 years. Two had completed elementary school, 2 with incomplete high school and 1 university in progress. All of them without social work.

Paracoccidioidomycosis due to Paracoccidioides brasiliensis S1 plus HIV co-infection.

BACKGROUNDParacoccidioidomycosis (PCM) is one of the most important systemic mycoses in Latin America and the leading fungal cause of mortality in non-immunosuppressed individuals in Brazil. However, HIV/PCM co-infection can increase the clinical severity in these co-infected patients. This co-infection is rarely reported in the literature mainly because of the different epidemiological profiles of these infections. Furthermore, PCM is a neglected and non-notifiable disease, which may underestimate the real importance of this disease. The advent of molecular studies on the species of the genus Paracoccidioides has expanded the knowledge regarding the severity and the clinical spectrum in PCM. In this context, the development of studies to describe the association of the Paracoccidioides phylogenetic cryptic species in vulnerable populations, such as HIV-infected patients, appears relevant.OBJECTIVETo describe the clinical, epidemiological, therapeutic and prognostic aspects in HIV/PCM co-infected patients, along with the molecular identification of the Paracoccidioides species involved in these cases.METHODSThe investigators performed a molecular and clinical retrospective study involving HIV/PCM co-infected patients, from a reference centre for PCM care in the endemic area of Rio de Janeiro, Brazil, from 1998 to 2015. Molecular identification of the fungal strains was done by amplification of partial sequences of arf and gp43 genes.FINDINGSOf 89 patients diagnosed with PCM by fungal isolation in the culture, a viable isolate was recovered for molecular analysis from 44 patients. Of these 44 patients, 28 (63.6%) had their serum samples submitted for enzyme immunoassay tests for screening of HIV antibodies, and 5 (17.9%) had a positive result. All cases were considered severe, with a variable clinical presentation, including mixed, acute/subacute clinical forms and a high rate of complications, requiring combination therapy. Paracoccidioides brasiliensis S1 was the species identified in all cases.CONCLUSIONSHIV/PCM co-infection can change the natural history of this fungal disease. The authors reinforce the need to include HIV screening diagnostic tests routinely for patients with PCM.

HIV misdiagnosis: A root cause analysis leading to improvements in HIV diagnosis and patient care

BackgroundStandard diagnostic testing for HIV infection has traditionally relied on a high sensitivity HIV antibody screening test using an enzyme-linked immunosorbent assay (ELISA) followed by a high specificity antibody confirmatory test such as a Western Blot. Recently several of the screening assays have been enhanced with an ability to identify p24 antigen thereby narrowing the diagnostic window. ObjectivesTo explore the implications of enhanced HIV screening methods that may be leading to HIV misdiagnoses. Study designA patient deemed to be an HIV infected ‘elite controller’ was found to be misdiagnosed when undergoing detailed investigations prior to initiating antiretroviral therapy. A root cause analysis was performed to identify the causative factors of this misdiagnosis. A retrospective review of all “elite controllers” in Alberta, Canada revealed challenges of current HIV testing algorithms. ResultsTechnical and human factors were identified as being causative in this HIV misdiagnosis including (i) high rates of false reactive results on the Abbott ARCHITECT HIV-1&2 COMBO EIA, (ii) human error in reading the initial Western blot, (iii) HIV algorithmic directives in which confirmatory (Western blot) testing was not performed on a repeatedly reactive screen test. The outcome of this analysis identified opportunities for improvement, including implementation of a newly approved (automated) confirmatory assay and improved communication between the clinician and laboratory. ConclusionsHIV testing remains problematic despite significant advances in HIV test performance and algorithm development, presenting new and unexpected issues. Ensuring a high-quality management system including implementation of the latest HIV technologies and algorithms along with human resources and policies are required to minimize the impact of false positive diagnoses, especially in the era of universal screening and ‘test and treat’ recommendations.

Serum Albumin/Globulin ratio in Tuberculosis and HIV Patients any Relationship?

Background: Tuberculosis (TB) remains an important communicable disease all over the world. The serum protein levels in TB patients may be altered by low immunity, edema and decrease antioxidant activity. This study therefore evaluates the relationship between TB and serum proteins with emphasis on albumin/globulin ratio an important component for treatment and management of TB. The study also aimed at comparing albumin/globulin ratio of tuberculosis patients, HIV patients, those on drugs and naive patients. Materials and Method: A total of 120 participants (42 control and 78 patients) aged between 15 years-65 years and sex-matched attending Plateau State Specialist Hospital were enrolled. Total protein was estimated using Biuret method and albumin by Bromocresol green method, serum globulin value was obtained by subtracting albumin from total protein then albumin/globulin ratio was calculated. Screening for HIV antibody was done using Determine strip and confirmed with Unigold. Results: Evaluated albumin/globulin ratio (1:4) was obtained in the TB case when compared to control group (p = 0.002). The albumin was significantly higher in study group compared to control (2.95 ± 0.86 and 2.75 ± 0.65 g/dl) while total protein and globulin was significantly lower (6.17 ± 1.66 and 6.76 ± 0.86 g/dl, p = 0.011 and 3.22 ± 1.9 and 3.97 ± 0.86 g/dl with p = 0.016. Patients seropositive for HIV antibody had a decrease in serum total protein, albumin and globulin but high albumin/globulin ratio. Total protein, albumin, globulin and albumin/globulin of TB patients not on drugs were elevated compared to those currently undergoing treatment. Age group < 30 years when compared with age group between 30-40 years showed significant low albumin and albumin/globulin ratio (2.74 ± 0.75 and 3.10 ± 0.72 g/dl, p = 0.025 and 0.97:1 ± 0.66and 1.42:1 ± 1.47, p = 0.042). Conclusion: Our work suggests that individuals < 30 years had hypoproteinaemia which maybe lead to low immunity. Our results also suggests that albumin/globulin ratio of TB patients on drugs were higher which may be due to hyperalbunaemia observed in this group. For effective treatment and management of TB infected individuals, appropriate use of drugs, adherence to treatment plan, close monitoring of dietary intake is needful in building and improving immunity.

Screening for acute HIV infections and estimating HIV incidence among female sex workers from low-grade venues in Guangxi, China.

BackgroundGuangxi has become one of the provinces with the most severe HIV-1 epidemic in China, where heterosexual contact is the dominant transmission route. However, data of acute HIV infections and HIV incidence among female sex workers (FSWs) from low-grade venues are scant.MethodsA cross-sectional survey was performed among FSWs from low-grade venues in Guangxi. HIV antibody screening was performed by rapid testing (RT). HIV antibody–negative specimens were screened by pooled nucleic acid amplification testing (NAAT) for acute HIV infections. HIV antibody-positive specimens were further analyzed by Western blot (WB), followed by an HIV-1 BED capture enzyme immunoassay (BED-CEIA) to identify the recent infections. HIV-1 incidence was estimated by the data of pooled NAAT and BED-CEIA, respectively.ResultsA total of 7936 FSWs were recruited and answered the questionnaires. We successfully collected the blood samples from 6469 (81.5%) participants, of which 139 (2.1%) were HIV antibody–positive and 6330 (97.9%) were HIV antibody-negative by RT. With pooled NAAT, 7 cases were found to be HIV RNA positive, representing an additional 5.0% of HIV-infected persons and an estimated HIV incidence of 1.45 (95% CI: 1.17–1.76) per 100 person years. There were 137 positive and 2 indeterminate by WB, of which 124 (90.5%) positive specimens were subjected to BED-CEIA testing identifying 28 recent infections. The HIV incidence determined by BED-CEIA testing was 1.04 (95% CI: 0.65–1.43) per 100 person years. The overall prevalence of HIV among FSWs from low-grade venues in Guangxi was 2.2% (95% CI: 1.9–2.6).ConclusionsWe found that the addition of HIV RNA screening to routine HIV antibody testing significantly improved the detection of HIV infection among FSWs from low-grade venues in Guangxi. Our findings also provided the useful baseline data of HIV incidence among this population for targeting local HIV prevention, intervention, monitoring and treatment.

Usefulness of enzyme immunoassay (EIA) for screening of anti HIV antibodies in urinary specimens: A comparative analysis

BackgroundStandard HIV testing is done using serum or plasma. FDA approved ELISA to screen urine for IgG antibodies to HIV-1 in 1996. It is a simple, noninvasive test and is appropriate for developing countries where health care personnel may not be professionally trained or where clean needles for drawing blood may not always be available. Methods436 individuals with high-risk behavior and strong clinical suspicion of HIV infection were screened for IgG antibodies to HIV-1 in urine by ELISA. Urine HIV testing was performed by enzyme immunoassay, at the ongoing Voluntary Confidential Counseling and Testing Center (VCCTC) at a large tertiary care microbiology lab. The individuals enrolled for the study had high-risk exposure to the virus and majorities were from a state with a high incidence of HIV infection. In all individuals, both serum and urine were tested for IgG antibodies to HIV-1. ResultsOverall, 135 individuals (30.96%) were HIV-positive, of whom 96 (71%) had never previously tested positive; 87% of those who tested positive received their results, and most were referred for medical care. Sensitivity, specificity and predictive values of HIV-1 urine ELISA test kit were determined. Sensitivity was found to be 89.6%; 95% CI [82.9–94.0], specificity 97.3%; 95% CI [94.6–98.8], positive predictive value 93.8%; 95% CI [87.8–97.1] and negative predictive value 95.4%; 95% CI [92.3–97.4]. ConclusionEfficiency, sensitivity, and specificity of the urine-based screening for HIV-1 test kits were excellent as compared to the reference test.

An analysis on positive HIV antibody in blood donors in Meizhou during the period of 2007 to 2012

Objective To provide scientific support for the establishment of strategies for blood safety and management by investigating HIV infection in blood donors in Meizhou.Methods The blood samples from blood donors were screened for HIV antibody by ELISA in Meizhou during the period of 2007 to 2012.The suspect samples of primary screening for HIV antibody were sent to Meizhou municipal center for disease control and prevention for further test and HIV antibody was confirmed by Western blot.The confirmed samples were determined as HIV antibody positive.Results Of 162 896 blood donors in Meizhou during the peiod of 2007 to 2012,16 were positive with HIV antibody,with a positive rate of 9.82/100,000.There were no significant differences in the positive rate of HIV antibody in blood donation population among different years.All the donors with positive HIV antibody were male and most of them were young adults.Conclusions Blood collection agencies should strengthen laboratory quality management,vigorously carry out popularization of knowledge about AIDS,and reduce the risk of spread of HIV by transfusion to the minimum level. Key words: Blood donation; AIDS; Confirmatory test; Epidemic characteristics

Cost effectiveness of screening strategies for early identification of HIV and HCV infection in injection drug users.

ObjectiveTo estimate the cost, effectiveness, and cost effectiveness of HIV and HCV screening of injection drug users (IDUs) in opioid replacement therapy (ORT).DesignDynamic compartmental model of HIV and HCV in a population of IDUs and non-IDUs for a representative U.S. urban center with 2.5 million adults (age 15–59).MethodsWe considered strategies of screening individuals in ORT for HIV, HCV, or both infections by antibody or antibody and viral RNA testing. We evaluated one-time and repeat screening at intervals from annually to once every 3 months. We calculated the number of HIV and HCV infections, quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs).ResultsAdding HIV and HCV viral RNA testing to antibody testing averts 14.8–30.3 HIV and 3.7–7.7 HCV infections in a screened population of 26,100 IDUs entering ORT over 20 years, depending on screening frequency. Screening for HIV antibodies every 6 months costs $30,700/QALY gained. Screening for HIV antibodies and viral RNA every 6 months has an ICER of $65,900/QALY gained. Strategies including HCV testing have ICERs exceeding $100,000/QALY gained unless awareness of HCV-infection status results in a substantial reduction in needle-sharing behavior.DiscussionAlthough annual screening for antibodies to HIV and HCV is modestly cost effective compared to no screening, more frequent screening for HIV provides additional benefit at less cost. Screening individuals in ORT every 3–6 months for HIV infection using both antibody and viral RNA technologies and initiating ART for acute HIV infection appears cost effective.

Programa de cribado de VIH/sida en las oficinas de farmacia en la Comunidad Autónoma del País Vasco

ObjectivesTo describe the outcomes of the pilot program of a rapid HIV antibody screening test offered at Basque pharmacies, the socio-demographic characteristics of users and their acceptance of the test. MethodsUsers of a rapid HIV antibody screening test (20 pharmacies) were surveyed. A random sample of 3514 tests (N = 806) performed in 1 year was taken. Statistical analyses included exact tests. ResultsThere were 806 valid questionnaires. Seven tests were positive (0.85%; 95% confidence interval: 0.34-1.75); five of the users with positive tests were men. The mean age was 36.2 years (standard deviation = 11.0; range: 16-82 years; 70.7% men). Users’ risk behavior was predominantly heterosexual and half of the users (58.6%) had no previous HIV tests. The main reasons for choosing this test were its speed, and the convenience and accessibility of community pharmacies. ConclusionsThis new rapid HIV antibody screening test in community pharmacies could supplement other HIV screening programs currently in operation.

Serum proteins in health and in patients with pulmonary tuberculosis in Nigeria

Tuberculosis (TB) remains an important communicable disease all over the world. We therefore undertook this study to evaluate the relationship between TB and serum protein levels. 210 patients with pulmonary TB (PTB) aged 18 years and above from Lagos metropolis and age- and sex-matched controls were studied. Both cases and controls had serum proteins levels evaluated. Serum total globulin was estimated by subtracting the albumin from the total serum protein. Screening for HIV antibodies was done using ELISA (Welcome Diagnostics, pasteur, Marnes-la-cognetee, France); and confirmed with Western Blot test (Dupont de Nemours, USA). Hypoalbuminaemia was detected in 184 (87.60%) of the cases versus 26 (12.38%) of the controls (P=0.001). Hypergammglobulinaemia was higher among cases compared to controls, 189 (90%) versus 90 (42.86%) (P=0.001). The protein sub-fraction, gammaglobulin was also higher in the cases compared with controls [mean 41.45 ± 11.21 vs. 29.42 ± 6.76% (p=0.005)]. Alpha-1 and alpha-2 globulin sub-fractions were however normal in both study groups. HIV antibody test was positive in 11/153 (7.19%) of those who accepted testing. Patients with PTB had lower serum total proteins and serum albumin but higher plasma gammaglobulin levels than controls. Keywords: Serum proteins, TB, HIV, Nigeria.

Screening Acute HIV Infections among Chinese Men Who Have Sex with Men from Voluntary Counseling &amp; Testing Centers

BackgroundRecent studies have shown the public health importance of identifying acute HIV infection (AHI) in the men who have sex with men (MSM) of China, which has a much higher risk of HIV transmission. However, cost-utility analyses to guide policy around AHI screening are lacking.Methodology/Principal FindingsAn open prospective cohort was recruited among MSM living in Liaoning Province, Northeast China. Blood samples and epidemiological information were collected every 10 weeks. Third-generation ELISA and rapid test were used for HIV antibody screening, western blot assay (WB) served for assay validation. Antibody negative specimens were tested with 24 mini-pool nucleic acid amplification testing (NAAT). Specimens with positive ELISA but negative or indeterminate WB results were tested with NAAT individually without mixing. A cost-utility analysis of NAAT screening was assessed. Among the 5,344 follow-up visits of 1,765 MSM in 22 months, HIV antibody tests detected 114 HIV chronic infections, 24 seroconverters and 21 antibody indeterminate cases. 29 acute HIV infections were detected with NAAT from 21 antibody indeterminate and 1,606 antibody negative cases. The HIV-1 prevalence and incidence density were 6.6% (95% CI: 5.5–7.9) and 7.1 (95% CI: 5.4–9.2)/100 person-years, respectively. With pooled NAAT and individual NAAT strategy, the cost of an HIV transmission averted was $1,480. The addition of NAAT after HIV antibody tests had a cost-utility ratio of $3,366 per gained quality-adjusted life year (QALY). The input-output ratio of NAAT was about 1∶16.9.Conclusions/SignificanceThe HIV infections among MSM continue to rise at alarming rates. Despite the rising cost, adding pooled NAAT to the HIV antibody screening significantly increases the identification of acute HIV infections in MSM. Early treatment and target-oriented publicity and education programs can be strengthened to decrease the risk of HIV transmission and to save medical resources in the long run.

Evaluation of pooled rapid HIV antibody screening of patients admitted to a San Diego Hospital

Current HIV screening guidelines in the United States recommend expanding the scope of HIV screening to include routine screening in health care settings; however, this will require increased resources. Since testing of pooled samples can decrease costs, the test characteristics of pooled rapid antibody testing were determined and optimal pool sizes were estimated for populations with HIV prevalence ranging from 0.25% to 10%. Based on these results, pooled testing methods were evaluated for screening patients admitted to hospital in San Diego, California. Evaluation of pooled antibody testing on samples collected from individuals with known HIV infection found only a modest reduction in sensitivity. These false negative results were only found among samples with very low optical density readings (<0.125 by the ADVIA Centaur® HIV assay). These readings are considered as HIV negative by the ADVIA Centaur® HIV assay, and therefore likely correspond to samples collected during acute infection. Further evaluation of pooled testing of samples collected from individuals during recent infection, found that mini-pool testing of five samples detected HIV antibody in 86% of samples taken within 60 days of the initial infection and 92% of samples taken within 90 days of the initial infection. Based on estimations of optimal pool sizes for low prevalence populations, it was decided to evaluate mini-pools consisting of 10 samples to screen the study's hospitalized patients. During this evaluation, the HIV prevalence among hospitalized patients was 0.8%, and the 10 sample mini-pool testing had 100% sensitivity and specificity. Additionally, pooled testing resulted in an 84.5% reduction in the number of rapid HIV antibody tests needed, as compared to testing each sample individually. Even when incorporating the increased costs of technician time, mini-pooled tested would have resulted in a net savings of 8760 USD for the 523 samples tested in the study. Taken together, these results indicate that pooled rapid antibody testing may reduce substantially the costs for HIV screening in low prevalence populations without a loss in accuracy.