HIV Diagnostic Tests - Forum For Collaborative Research
HIV Diagnostic TestsBernard M. Branson, M.D.Associate Director for Laboratory DiagnosticsDivision of H IV/AIDS PreventionCenters for Disease Control & PreventionThe views expressed in this presentation are those of the author and do notnecessarily represent those of the Centers for Disease Control and Prevention
Generations
1st and 2 nd Generation EIAPlasma/serum(1 h/37o C)Plasma/serumAntigen1st - Viral lysate2nd – Recombinant proteinsor synthetic peptidesIgG HIV antibodyenzymeEnzymedetectionanti-human IgGDetects HIVIgGColorreagent
EIAWestern blotIFA
3rd Generation “Sandwich” EIAHIV antibodyPlasma/serumIgGAntigen:Recombinant proteinsor synthetic peptidesIgMenzymeEnzymedetectionHIV antigenDetects HIVIgM or IgGColorreagent
4th Generation Combo EIAPlasma/serumHIV antibodiesp24 antigenHIV antigenp24 antibodyEnzymedetectionHIV antigenp24 antibodyDetects IgMor IgGantibody orp24 antigeniColorreagent
HIV Infection and Laboratory MarkersHIV RNA (plasma)HIV AntibodyHIV p24 Ag220102030405060708090100DaysInfection4th 3rdgen gen2ndgen1stgenModified after Busch et al. Am J Med. 19979
19922000HIV-1/HIV-2EIAHIV-1/HIV-2Peptide EIA3rd &4th genAbbottlab screeningtests1987Genetic SystemsVironostikaEIA1985AbbottHIV-1 enetic SystemsrLAV (HIV-1)1st gen confirmatory2003GS HIV-1HIV-2 Plus OEIA2002OraQuickHIV-1/HIV-2Rapid Test20112008Bio-RadOrtho VitrosAg/AbHIV 1 2ComboCIA2006EIA2010Advia CentaurAbbott1/O/2ArchitectCIAAg/AbCombo CIA2004MultispotHIV-1/HIV-2Rapid Test2003UnigoldRevealHIV-1 RapidTests2009Avioq d Test2nd gen rapid tests
Uni-Gold Recombigen2003Multispot HIV-1/HIV-22004Reveal G32003Clearview Complete HIV 1/22006Clearview HIV 1/2 Stat Pack2006OraQuick Advance2002
Rapid HIV Test ResultswithoutRapid Test Kits
Random Access Multiplatformanalyzers for HIV testingOn-board Refrigeration of Multiple Different Assays
Random Access Multiplatformanalyzers for HIV testingSTAT sample requests without pausingResults in 60 minutes
ADVIA Centaur H IV 1/O /2 Enhanced (EH IV) Chemiluminescentimmunoassay 3 rd generation format- H IV-1: gp41, p24- H IV-2: gp36- group O Time to result 1 hour FDA-approved July 2006
Ortho VITROS ECi/ECiQ Chemiluminescentimmunoassay 3 rd generation format- H IV-1: gp41, gp120, p24- H IV-2: gp36- group O Time to result 1 hour Repeat only borderline results FDA-approved March 2008
Abbott Architect 4 th Generation Ag/AbCombo Assay Chemiluminescentimmunoassay Detects p24antigen and H IVantibody Time to result: 29minutes FDA-approvedJune 22, 2010
APTIMA Qualitative HIV-1 RNA Assay Aid to H IV-1 diagnosis Diagnosis of acute H IV-1infection in antibody-negativepersons Confirmation of H IV-1infection in antibody-positivepersons when it is reactive FDA-approved July 2006
Bio-Rad GS HIV Combo Ag/Ab EIA Microwell plate EIA 3rd generation format:- HIV-1: gp160- HIV-2: gp36- Group O p24 antigen FDA-approved July 25, 2011
Relative Seroconversion SensitivityCumulative frequency of positive tests1.000.90Genprobe0.80Architect 4thBioRad 4th0.70Advia 3rdVitros 3rd0.60Abbott 3rdBioRad 0.20UnigoldOraq Adv0.100.00-50-40-30-20-100102030days to WB positive 26 seroconverters were analyzed with 14 tests 17 seroconverters with WB positive used for cumulative frequency analysis
Modified from Masciotra et al, J Clin Virol 2011and Owen et al, J Clin Micro 2008Days before WB positive0510152025166 specimens, 17 Seroconverters - 50 % Positive Cumulative FrequencyVironostka ( 2)Unigold (-2)OraQuick (-1)WB positiveCOMPLETE HIV-1/2 (-5)HIV-1/2 STAT-PAK (-5)Multi-Spot (-7)Reveal G3,Avioq (-6)INSTI (-9)Determine Ag/Ab Combo (-15)Advia (-14)Vitros (-13)GS 1/2 O (-12)Architect Ag/Ab Combo (-20)Bio-Rad Ag/Ab Combo (-19)APTIMA (-26)Sequence of Test Positivity Relative to WB
Acute Infections in MSM detected by RNA only 0.3% of 14,005 frequently tested MSM in SeattleSTD clinic; 20% of all HIV infections detected- Stekler et al, Clin Infect Dis 2009 26 (74%) of 35 AHI cases detected in LA at MSMclinic; 25% of all HIV infections detected- Patel et al, Archives Int Med 2010 0.08% of 21,425 STD clinic patients in NewYork City; 9% of all HIV infections detected;94% were MSM- Shepard et al, MMWR 2009
RNA vs. 4 th Generation Ag/Ab Assay RNA / 3 rd gen-negative specimens detected by4 th generation EIA: 38of 46 (83%) – Australia* 10 of 14 (71%) – CDC AHI study* * 51 of 61 (84%) – CDC panel* * * 4days after RNA – 9 seroconversion panels* * ** Cunningham P, HIV Diagnostics Conf 2007** Patel P, CROI 2009*** Owen M, CROI 2009
On the Horizon
Point-of-care finger-stickviral load and CD4analyzerAg/Ab Rapid TestPoint-of-careHIV-1/2 antibodydifferentiation assay withautomated reader
Jul 25, 2011 · Multispot HIV-1/HIV-2 2004 Reveal G3 2003 OraQuick Advance 2002 Clearview Complete HIV 1/2 2006 Clearview HIV 1/2 Stat Pack 2006 . Rapid HIV Test Results without Rapid Test Kits . On-board Refrigeration of Multiple Different Assays . . COMPLETE HIV-1/2 (-5) HIV-1/2 STAT-PAK
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HIV medication costs approximately 15,000 Euro per year. In Finland, the place of domicile of the HIV positive person pays for the medication. How will HIV affect my life? HIV will not affect your work, studies or hobbies. A person with HIV can date, get married and have children. HIV will not stop you from living a full life.
Epi Profiles Summary: St. Louis HIV Care Region 2017 Epidemiologic Profiles of HIV, STD, and Hepatitis in Missouri 63 Figure 5. HIV disease deaths*, by selected race and year of death, St. Louis HIV Care Region, 2008-2017† *Includes deaths that have occurred among those diagnosed with HIV disease in the St. Louis HIV Care Region.
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Although adventure tourism is recognized as an important, growing tourism segment, primary research to quantify the size and scope of this market in the U.S. or internationally (Schneider 2006) has been lacking. For this reason, George Washington University, along with its partners, the Adventure Travel Trade Associ-ation (ATTA) and Xola Consulting, sought to better understand the adventure .
