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confusion over generation of tests
Jan 3, 2006

There's a lot of talk about the generation of tests. And it's proven difficult to find a straight answer, even from the people who make the darn tests. But being that you're smarter than all of them (hehe), would you be so kind as to tell me what generation the current Oraquick Rapid HIV antibody (finger-prick) test is? And what exactly does this mean in terms of accuracy? Thank you!

Response from Dr. Frascino

Hello,

This may seem like a straightforward question; however, the answer is anything but!

ELISA (enzyme-linked immunosorbent assay) is the most commonly used test to screen for HIV, because of its relative simple methodology and inherent high sensitivity. (Tests with high sensitivities produce few false-negative results.) Third-generation ELISA tests use an "antigen-sandwich" type of assay that allows anti-HIV antibodies to be detected somewhat earlier than earlier generations (versions) of ELISA tests. Fourth generation tests combine a third-generation format (antigen-sandwich) for anti-HIV antibody detection and the ability to simultaneously detect HIV p24 antigen using ELISA techniques. These combination assays allow for even earlier detection of those infected.

Rapid HIV antibody tests use a different technology called "dot blot" or "immunoblot" to detect specific HIV antibodies. Since the technologies are different, we cannot apply the same "generational" status to them. What we can say is that both sensitivity (few false-negatives) and specificity (few false-positives) of HIV rapid tests, when properly performed, exceed 99%. In other words, these tests are as accurate as ELISA tests for detection of HIV antibodies.

Hope that helps clarify things for you.

Stay well. Happy New Year!

Dr. Bob



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