Diagnostic, Monitoring and Resistance Laboratory Tests for HIV

Table of Contents

• I. Introduction
• II. Diagnostic Tests
• A. Antibody Tests
• 1. HIV-1 Antibody Screening Assays
• 2. HIV-1 Confirmatory Antibody Assays
• 3. HIV-2 Antibody Screening
• B. Viral Identification Assays
• 1. DNA Polymerase Chain Reaction (DNA-PCR)
• 2. Plasma HIV RNA Assays
• III. Monitoring Tests
• A. Lymphocyte Analysis
• B. Viral Load Assays
• 1. Roche Amplicor HIV-1 Monitor and Roche Amplicor HIV-1 Monitor Ultrasensitive (RT-PCR)
• 2. Branched Chain DNA (bDNA)
• 3. Nucleic Acid Sequence-Based Assay (NASBA)
• 4. Other Viral Load Tests
• C. Drug Resistance Tests
• 1. Genotyping
• 2. Phenotyping
• 3. Co-Receptor Tropism Assay
• 4. Other Drug Resistance Tests
• D. Human Leukocyte Antigen Testing
• References
• Appendix A: Assay Procedures
• Appendix B: Enzyme-Linked Immunosorbent Assay
• Appendix C: Western Blot
• Appendix D: Immunofluorescence Assay (IFA)
• Appendix E: Amplicor HIV-1 Monitor Test Format
• Appendix F: Versant bDNA Signal Amplification Assay
• Appendix G: Nucleic Acid Amplification System

I. Introduction

Technologic advances in HIV laboratory testing continue to aid in screening, diagnosis, and patient management. Effective methods for detection of HIV-related laboratory markers are critical for both accurate HIV screening and for monitoring patients for disease progression and viral resistance to therapy. This chapter provides an overview of currently available HIV laboratory screening methods, viral load assays, and HIV resistance tests. Many new technologies that will further enhance testing methods are in various stages of development.

Patients presenting for testing within 36 hours of exposure to HIV should be assessed for post-exposure prophylaxis (see Post-Exposure Prophylaxis Guidelines). Expert advice may be obtained from the National Clinicians' Consultation Center PEP Line at 1-888-HIV-4911 (1-888-448-4911).