HIV AIDS diagnostic study of choice: Difference between revisions
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===Rapid Testing Assays=== | ===Rapid Testing Assays=== | ||
The rapid tests is completed in about 20-30 mins making it ideal in primary care and mobile clinics. Non-laboratory staff can perform these test as it require finger prick blood sample or oral fluid. Although these are less sensitive than EIAs; however, their specificity is higher. <ref name="pmid30487166">{{cite journal| author=Parekh BS, Ou CY, Fonjungo PN, Kalou MB, Rottinghaus E, Puren A | display-authors=etal| title=Diagnosis of Human Immunodeficiency Virus Infection. | journal=Clin Microbiol Rev | year= 2019 | volume= 32 | issue= 1 | pages= | pmid=30487166 | doi=10.1128/CMR.00064-18 | pmc=6302353 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30487166 }} </ref> | The rapid tests is completed in about 20-30 mins making it ideal in [[primary care]] and mobile clinics. Non-laboratory staff can perform these test as it require [[finger prick]] [[blood]] sample or [[oral fluid]]. Although these are less sensitive than EIAs; however, their specificity is higher. <ref name="pmid30487166">{{cite journal| author=Parekh BS, Ou CY, Fonjungo PN, Kalou MB, Rottinghaus E, Puren A | display-authors=etal| title=Diagnosis of Human Immunodeficiency Virus Infection. | journal=Clin Microbiol Rev | year= 2019 | volume= 32 | issue= 1 | pages= | pmid=30487166 | doi=10.1128/CMR.00064-18 | pmc=6302353 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30487166 }} </ref> | ||
Revision as of 10:03, 16 December 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kanwal Khamuani
Overview
Diagnostic Study of Choice
Study of choice
Fourth generation test(ELISA/ELI/MEIA/ELFA/ECLIA) have high sensitivity; therefore they are used as confirmatory test. These test can detect both p24 antigen as well as HIV antibodies.[1]
Screening Immunoassays
There have been five generations of enzyme immunoassays(EIAs) that use different [[antigen] compositions and detection chemistries to give precise and high volume samples for laboratories.[2]
- First Generation Assay: It used antigen lysate preparations to detect antibodies; however due to high false positivity it was replaced by highly specific immunoassays and western blot techniques.
- Second Generation Assay: Proteins derived from Immunodominant regions(IDR) of HIV-1 proteins and gp36 of HIV-2 were used to increase sensitivity and decrease false positivity.
- Third Generation Assay: Detection of Ig G antibodies by using antigens such as gp160 derived from HIV-1 group M, recombinant p24, recombinant peptide from HIV-2 gp36 IDR and synthetic peptide from HIV-1 group O. It also detected HIV-1 IgM to further reduce window period.
- Fourth Generation: It detected both antigen and antibodies at the same time using fully automated chemiluminescent microparticle.
- Fifth Generation: It used multiplex format to detect distinguished p24 antigen of HIV-1 and HIV-2.
Confirmatory Immunoassays
The specimens that were reactive with EIAs need to be retested with more specific confirmatory test which is Western Blot using a gradient purified HIV lysate, electrophorese and suffused onto nitrocellulose strips. For WB to be considered positive, it has to contain antibodies reactive to p24 antigen and envelope glycoproteins.[2]
Rapid Testing Assays
The rapid tests is completed in about 20-30 mins making it ideal in primary care and mobile clinics. Non-laboratory staff can perform these test as it require finger prick blood sample or oral fluid. Although these are less sensitive than EIAs; however, their specificity is higher. [2]
The comparison of various diagnostic studies for [disease name]
| Test | Sensitivity | Specificity |
|---|---|---|
| Test 1 | ...% | ...% |
| Test 2 | ...% | ...% |
[Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity
Diagnostic results
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
- [Finding 1]
- [Finding 2]
Sequence of Diagnostic Studies
The fourth generation assays(EIAs, RDTs, CLIAs, ECLs) are performed when HIV is suspected.[3]
- A reactive test is followed by confirmatory second assay from any other fourth generation test.
- A nonreactive test is reported as a negative HIV patient.
If a second line assay is positive:
- It is followed by a retesting prior to starting ART.
If a second line assay is negative:
- Both first line and second line assay are repeated.
Upon repetition if both test give same results as above:
- perform third line assay
Upon repetition if both are negative:
- It is reported as HIV negative patient or the test is repeated agin if high risk features are present.
If results of third line are positive:
- patient is asked to be retested after 14 days
If results of third line assay are negative:
- Patient is reported as HIV negative.
OR
The various investigations must be performed in the following order:
- [Initial investigation]
- [2nd investigation]
Name of Diagnostic Criteria
It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
OR
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
OR
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
- Criteria 1
- Criteria 2
- Criteria 3
OR
IF there are clear, established diagnostic criteria
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
OR
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
IF there are no established diagnostic criteria
There are no established criteria for the diagnosis of [disease name].
References
- ↑ Zulfiqar HF, Javed A, Afroze B, Ali Q, Akbar K; et al. (2017). "HIV Diagnosis and Treatment through Advanced Technologies". Front Public Health. 5: 32. doi:10.3389/fpubh.2017.00032. PMC 5339269. PMID 28326304.
- ↑ 2.0 2.1 2.2 Parekh BS, Ou CY, Fonjungo PN, Kalou MB, Rottinghaus E, Puren A; et al. (2019). "Diagnosis of Human Immunodeficiency Virus Infection". Clin Microbiol Rev. 32 (1). doi:10.1128/CMR.00064-18. PMC 6302353. PMID 30487166.
- ↑ Fearon M (2005). "The laboratory diagnosis of HIV infections". Can J Infect Dis Med Microbiol. 16 (1): 26–30. doi:10.1155/2005/515063. PMC 2095005. PMID 18159524.