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Diagnostic testing for HIV type 1 RNA in seronegative blood
D Ritter1, J Taylor, R Walkenbach
1Department of Pathology, St Louis University School of Medicine, MO, USA.
American Journal of Clinical Pathology
|January 13, 2000
Summary
Routine HIV-1 RNA testing in pooled blood samples is feasible and can identify over 95% of acutely infected individuals. While more costly than antibody tests, it aids early detection for timely antiretroviral therapy.
Area of Science:
- Virology
- Public Health
- Diagnostic Testing
Background:
- Early detection of Human Immunodeficiency Virus type 1 (HIV-1) infection is crucial for effective treatment and prevention of transmission.
- Current diagnostic methods primarily rely on antibody detection, which can have a significant window period.
- Assessing the feasibility of viral RNA testing in public health settings is essential for improving early diagnosis.
Purpose of the Study:
- To evaluate the feasibility of implementing routine diagnostic testing for HIV-1 RNA at a publicly funded testing site.
- To determine the sensitivity and frequency of HIV-1 RNA detection in pooled blood samples.
- To compare the cost-effectiveness of HIV-1 RNA testing versus traditional antibody testing.
Main Methods:
- Utilized a commercial polymerase chain reaction (PCR) assay to detect HIV-1 RNA in pooled seronegative blood samples.
- Estimated the recovery rate of viral RNA from pooled samples compared to freshly prepared plasma.
- Calculated the frequency of HIV-1 RNA in seronegative samples and the ratio to confirmed positive specimens.
Main Results:
- HIV-1 RNA was detectable in pooled samples, with an estimated recovery of at least 8% of viral RNA found in fresh plasma.
- Screening HIV-1 RNA in serum pools could identify over 95% of acutely infected patients.
- The estimated frequency of HIV-1 RNA in seronegative samples ranged from 19 to 601 per million specimens.
- The cost per identified HIV-1 infected sample was 10-fold higher with HIV-1 RNA assay compared to HIV antibody ELISA.
Conclusions:
- Routine HIV-1 RNA testing is feasible in public health settings.
- HIV-1 RNA screening offers a significant advantage in identifying acutely infected individuals, potentially improving treatment outcomes.
- Despite higher initial costs, HIV-1 RNA testing may be warranted for high-risk populations due to the benefits of early antiretroviral therapy and reduced transmission potential.