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Diagnostic, Monitoring and Resistance Laboratory Tests for HIV

January 2014

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Table of Contents


Editor's Note

Diagnostic HIV laboratory tests and interpretation algorithms evolve; individual laboratories have internal protocols for reporting tests with preliminary results. Indeterminate, inconclusive, non-diagnostic, and pending validation are among the terms used when preliminary results cannot be classified definitively. The clinician should contact the appropriate laboratory authority to determine the significance of the non-definitive results and the supplemental testing that would be indicated. This is of particular importance with tests from pregnant women, newborn children, and patients with suspected acute HIV infection or HIV-2. Clinicians should become familiar with the internal test-reporting policies of their institutions.


Important Note (October 2013)

A new HIV diagnostic testing algorithm has been verified through scientific studies and offers several advantages over the traditional enzyme immunoassay (EIA)-Western blot algorithm, including earlier and more accurate detection of HIV infections, the ability to differentiate between HIV-1 and HIV-2 infections, and lower costs. Recommendations for its use are anticipated from the Centers for Disease Control and Prevention (CDC). The New York State Department of Health (NYSDOH) has issued a Dear Colleague letter to update clinicians about this new algorithm. This guideline is currently in the process of being updated to include information regarding the new algorithm.


Important Notes (June 2013)


Key to Abbreviated Terms
bDNABranched chain DNA
CDCCenters for Disease Control and Prevention
CIAChemiluminescent immunoassay
EIAEnzyme immunoassay
ELISAEnzyme-linked immunosorbent assay
FDAUS Food and Drug Administration
HLAHuman leukocyte antigen
NATNucleic acid test
OMTOral mucosal transudate
PBMCPeripheral blood mononuclear cell
PCRPolymerase chain reaction
RTReverse transcriptase
WBWestern blot


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).

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This article was provided by New York State Department of Health AIDS Institute.
 
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Reader Comments:

Comment by: Samir Hussain (India) Sat., Apr. 18, 2015 at 2:31 am EDT
HIV CMIA repeatedly reactive more than 20 months ELFA negative , W. BLOT showed HIV 1 &2 negative but didn't understand the remarks.

vaccinated to inactivated influenza(SANOFI),pneumococcal pcv13 & psv23 (MSD), Hep.B (ENGERIX B) 40 mcg 0,1,2,3,6 after got my first reactive result. I am a medical laboratory technician working for more than 15 years, had flu like symptoms 15 years ago when I first joined lab. Does my elfa will show positive near in future? No Rna PCR done yet. my weight is 82.5 till date, few skin rash in my legs (now very faint) observed 3 years, felling lightheadness, vertigo, left ear infection persists,using DREP(DWD). Please suggest. No ART taken so far.
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