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AIDS
Majority of persons infected with HIV present with AIDS soon or later.
Apart from Men, there is a increasing burden of Infections in Women. Implication on Mother to Child Transmission Female Adolescents are infected 3 - 6 times higher than male counterparts.
AIDS has turned out to be Social Problem.
Implication of AIDS
Being diagnosed as having HIV/AIDS has life time repercussions. Every body understands AIDS as a life threatening condition. A casual way of dealing as being HIV + will have Moral, Legal, and Social consequences.
All patients should be informed about consequences of Testing for HIV infection, Legality of respective National Laws should be followed. A pretest and posttest counseling is Growing importance, even in Developing countries. Todays debate on testing for HIV status as matter of Health protocol ?
A matter of great importance as in Blood donors to prevent infected blood being transfused. To diagnose the patients infected with HIV virus. For surveillance purpose. Persons with high risk behavior. In Pregnant women to prevent Mother to Child transmission. Patient's presenting with opportunistic infections.
A screening test posses high Sensitivity We rarely miss the Diagnosis in Infected patients. Done as mass screening procedure. Economical. Developing countries depend on these tests even for Diagnosis.
It is important to confirm all screening tests with Confirmatory tests, or we brand some one without infection as infected, Confirmatory tests differentiates false reactive tests. and identifies truly infected or not.
Confirmatory test
High degree of specificity
Before you declare a person infected with HIV / AIDS you should perform both methods. Faulty testing methods can lead to catastrophic consequences, and legal litigations.
Our aim to obtain 100 % specific results ? But impossible. As few may be infected and do not have sufficient antibodies to detect in the testing methods. Depend on time tested methods. Explore the reputation of the suppliers.
ELISA METHOD
Universally accepted test ,most popular even in the developing nations. Useful in large scale screening. A common method used in Blood banks in mass screening of Human blood.
Easy to perform Free from Radiation. Relatively specific Sensitive. With scientific advances we have advanced to new generation of testing methods Today we depend on 3rd and 4th generation ELISA methodologies.
Significance of ELISA
Most reliable screening test for HIV infection. 50% of the infected will show positive reactivity in < 22 days. 95% show reactivity < 6 weeks Sensitivity > 99.9 % But needs confirmation with Western Blot.
Helps in detection of early infections, Can detect all classes of antibodies including Ig M All isotypes of antibodies can be captured. But proving to be expensive to developing Nations.
th 4
A new generation Method in ELISA Can detect both Antigen and Antibody in the same run ( in the same ELISA Plate ) Helpful to make early diagnosis at least in few cases.
Helps in the early detection of HIV infection. Screening of Blood for HIV infection along with detection for antibody detection. Early diagnosis of HIV infection in resource poor nations. Monitoring Anti-retroviral therapy. But not a replacement for RNA quantization. Even P 24 Antigens are subject of false positive results.
Imperfect Sensitivity, Sensitivity to detect HIV2 ? Failing to detect HIV variants. Other technical errors.
HIV Western Blots. Line Immunoassay ( LIA ) Immuno fluorescent Assay ( IFA )
Utility is limited due technical and economical reasons
A Gold standard confirmatory test. When tested combined with ELISA specificity is > 99.9 %.
HIV viral antigens are separated as; gp160,gp120,p66,p55,p51,gp41,p31,p24, p17, and p15.
Interpretation depends on presence / absence of reactivity to specific antigens.
The antibodies in the serum should react with at least two of following antigens, gp 160/120 gp 41 p 24 If does not meet requirements, marked as indeterminate.
Absence of any reactivity to the bands is declared as Negative. False positives are rare. All doubtful results should be reported as Negative.
If not designed for HIV 2 inclusion, we miss HIV2 infections, Can give Indeterminate results in Pregnancy After administration of Tetanus Toxoid. Autoimmune conditions.
A growing importance Results can be issued within < 20 minutes. Limited protocols, and less demanding technical skills. But needs confirmation with ELISA / Western Blot testing. Can differentiate HIV 1 and HIV 2.
In patients in Labor whose Immune status is not known, Resource poor establishments. But needs confirmation with ELISA / WB
CD4 count measurements help for staging the diseases. Flow cytometry has become the prominent tool in estimations of CD4. Specimens should be promptly processed.
Most widely used predictor of HIV progression. Risk of progression to an AIDS defining illness, opportunistic infections or malignancy is high, when the counts drop below 200/mcl.
Estimation of percentages is more useful than CD4 counts. When the counts drops < 20% we have to watch for onset of opportunistic infections and malignancy.
Molecular Methods in
Diagnosis of AIDS
RT-PCR Need the use of Reverse transcriptase enzyme that converts RNA to DNA.
The testing is based on artificially replicating Nucleic acid sequence of the target ( viral sequence ) so that Millions to Billions are made available for detection.
The tests measure the amount of actively replicating HIV virus. Correlates with response to antiretroviral drugs Most helpful in diagnosis of HIV before Sero conversion. False positives should be possible with low viremia < 500 copies.
Saliva Urine
Detection of Ig G Detection of Ig G
Casual testing to be curtailed. To do with a purpose. HIV positive result has Moral,social,and Economic consequences. Post test counseling a must in all HIV+ individuals.
AIDS is
Caused by fascinating Virus to - Scientists, Friendly in approach to - Lovers. Dangerous to Life to - Infected. Dr.T.V.Rao,MD
STOP AIDS.
Dr.T.V.Rao MD. Professor of Microbiology e mail tvraodoctor2000@yahoo.co.in