This Article Full Text Full Text (PDF) Other Versions of this Article: JCM.02196-07v1 46/5/1588    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints and Permissions Copyright Information Books from ASM Press MicrobeWorld Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Owen, S. M. Articles by McDougal, J. S. Search for Related Content PubMed PubMed Citation Articles by Owen, S. M. Articles by McDougal, J. S.

 Previous Article  |  Next Article 

Journal of Clinical Microbiology, May 2008, p. 1588-1595, Vol. 46, No. 5
0095-1137/08/$08.00+0     doi:10.1128/JCM.02196-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Alternative Algorithms for Human Immunodeficiency Virus Infection Diagnosis Using Tests That Are Licensed in the United States

HIV Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333

Received 13 November 2007/ Returned for modification 14 January 2008/ Accepted 25 February 2008

Serodiagnosis of human immunodeficiency virus (HIV) infection in the United States has traditionally relied on a sequential two-test algorithm: an initial screen with an enzyme immunoassay (EIA) and reflex testing of EIA-reactive specimens with a more specific supplemental test such as Western blotting or immunofluorescence. The supplemental tests are tedious, subjective, and expensive. In addition, there have been major improvements in the performance and accuracy of the EIA tests as well as the introduction of rapid serologic tests (RT) and HIV nucleic acid amplification tests (NAAT). Related to these improvements is the possibility that alternative algorithms using combinations of currently approved HIV tests may function as well as if not better than the current algorithm, with more flexibility, improved accuracy, and lower cost. To this end, we evaluated the performance of 12 currently licensed tests and 1 in-house HIV test (6 EIA, 4 RT, and 3 NAAT) on panels of plasma samples from HIV-infected (n = 621 HIV type 1 [HIV-1] and 34 HIV-2) and uninfected (n = 513) people and of sequential specimens from people early in seroconversion (183 specimens from 15 patients). Test combinations were analyzed in two dual-test (sensitivity-optimized and specificity-optimized) algorithms and in a three-test (tie-breaking) algorithm, and performance was compared to the conventional algorithm. The results indicate that alternative algorithm strategies with currently licensed tests compare favorably with the conventional algorithm in detecting and confirming established HIV infection. Furthermore, there was a lower frequency of discordant or indeterminate results that require follow-up testing, and there was improved detection of early infection.

Published ahead of print on 5 March 2008.

This article has been cited by other articles:

• Pilcher, C. D., Hare, C. B. (2008). The Deadliest Catch: Fishing for HIV in New Waters. ANN INTERN MED 149: 204-205 [Full Text]