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Research Article Open access CC BY 4.0

HIV Diagnostic Algorithms in A Resource-Limited Setting: A Comparative Study

Fasakin KA, Ajayi OD, Ibijola AA, Adeniyi AA, Ajetunmobi WA, Ajetunmobi OA, Adewara OE, Bakare A, Oyegue BE

Journal of Advances in Medical and Pharmaceutical Sciences · pp. 79–94 · Published 7 Aug 2024

10.9734/jamps/2024/v26i7703

Abstract

Background: Adoption of appropriate HIV testing algorithm is essential for quality HIV diagnostic results. Whether rapid enzyme immunoassay (rEIA) or combination of rapid enzyme immunoassay and enzyme-linked immunosorbent assay (rEIA-ELISA) alternative confirmatory algorithm is enough to make accurate HIV diagnosis has been a subject of controversies. Recent evaluation of national algorithm for HIV testing presented some discrepancies in results. Again, current guideline prescribed discontinuity of Western blot supplemental test and its replacement with Geenius HIV-1/ HIV-2 differentiation test followed by nucleic acid testing. The objective of this study is to compare HIV-1 testing algorithms using ELISA-NAT algorithm as the gold standard for HIV-1 diagnosis, and rEIA-Western blot and ELISA-Western blot as alternative confirmatory algorithms for HIV-2 diagnosis. Methods: This is a comparative study involving a cohort of 173 (98.9%) HIV-positive subjects and two (1.1%) HIV-negative subjects initially diagnosed on the basis of rEIA algorithm. Plasma samples separated from ethylene diamine tetra-acetic acid anticoagulated blood were used for further analyses. Fourth generation HIV antigen-antibody kit was used for further testing to make up rEIA-ELISA algorithm. Analyses with Western blot 1 and 2 assays were done as supplemental tests to make up alternative rEIA-Western blot and ELISA-Western blot confirmatory algorithms. Research subjects were further tested for HIV-RNA under PEPFAR plan. The sensitivity, specificity, positive predictive value and negative predictive value of algorithms were compared using the descriptive statistics of the SPSS version 17. Results: The HIV testing analyses showed 100% sensitivity, specificity, positive predictive value and negative predictive value from algorithm to algorithm especially for HIV-1 diagnosis. Use of combined ELISA-NAT confirmatory algorithm validated outcomes of rEIA-Western blot and ELISA-Western blot alternative confirmatory algorithms for HIV-1 diagnosis. Among HIV-1 positive samples tested, 50.0-60.7% HIV-2 Western blot indeterminate result was obtained and 7.1-10.7% HIV-1/HIV-2 co-infections were observed. Conclusion: The rEIA or national algorithm and its combination with enzyme-linked immunosorbent assay are reliable alternative confirmatory algorithms for the diagnosis of established HIV-1infection in resource-limited settings but not for HIV-2. Diagnosing acute HIV infection with current algorithm is limited and still require further review.

Enzyme immunoassay enzyme-linked immunosorbent assay Western blot indeterminate results algorithm sensitivity specificity

References (19)

  1. 1 Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA [DOI]
  2. 2 Survival of Persons with and without HIV Infection in Denmark, 1995–2005 [DOI]
  3. 3 Human Immunodeficiency Virus (HIV) [DOI]
  4. 4 A Global Review of HIV Self-testing: Themes and Implications [DOI]
  5. 5 Couple-centred testing and counselling for HIV serodiscordant heterosexual couples in sub-Saharan Africa [DOI]
  6. 6 Reconstruction and Future Trends of the AIDS Epidemic in the United States [DOI]
  7. 7 Fourth-Generation Enzyme-Linked Immunosorbent Assay for the Simultaneous Detection of Human Immunodeficiency Virus Antigen and Antibody [DOI]
  8. 8 Interpretation and Use of the Western Blot Assay for Serodiagnosis of Human Immunodeficiency Virus Type 1 Infections [DOI]
  9. 9 Comparison of alternative interpretive criteria for the HIV-1 Western blot and results of the Multispot HIV-1/HIV-2 Rapid Test for classifying HIV-1 and HIV-2 infections [DOI]
  10. 10 Performance of an alternative laboratory-based algorithm for HIV diagnosis in a high-risk population [DOI]
  11. 11 Infections Prevented by Increasing HIV Serostatus Awareness in the United States, 2001 to 2004 [DOI]
  12. 12 Comparative evaluation of the Geenius HIV 1/2 Confirmatory Assay and the HIV-1 and HIV-2 Western blots in the Japanese population [DOI]
  13. 13 Performance of HIV rapid testing algorithm in Nigeria: Findings from a household-based Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) [DOI]
  14. 14 Potential for false-positive HIV test results using rapid HIV testing algorithms [DOI]
  15. 15 Evaluation of the Nigeria national HIV rapid testing algorithm [DOI]
  16. 16 Advances in laboratory testing for HIV [DOI]
  17. 17 Fourth generation human immunodeficiency virus (HIV) screening assays with an improved sensitivity for p24 antigen close the second diagnostic window in primary HIV infection [DOI]
  18. 18 Update on the laboratory diagnosis and monitoring of HIV infection [DOI]
  19. 19 Laboratory testing for the diagnosis of HIV infection : updated recommendations [DOI]

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