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HIV nucleic acid testing is recommended for discordant HIV antigen-antibody and antibody differentiation results but is often not performed. A review found 35% of these recommended HIV nucleic acid tests were not completed.

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Area of Science:

  • Medical Diagnostics
  • Infectious Disease Research
  • Clinical Laboratory Science

Background:

  • Current HIV diagnostic guidelines recommend confirmatory HIV nucleic acid testing (NAT) for discordant results from antigen-antibody screening and antibody differentiation immunoassays.
  • At this medical center, HIV NAT is not performed reflexively, meaning it requires a specific order.
  • Discordant results indicate a potential need for further investigation to accurately diagnose HIV infection.

Purpose of the Study:

  • To evaluate the adherence to recommended HIV nucleic acid testing protocols for discordant HIV immunoassay results.
  • To identify the rate at which recommended HIV NAT was not completed in cases of discordant HIV testing.
  • To assess potential gaps in the HIV diagnostic pathway at the medical center.

Main Methods:

  • A retrospective chart review was conducted.
  • The study analyzed cases where HIV antigen-antibody screening immunoassay and antibody differentiation tests yielded discordant results.
  • Data on the completion of recommended HIV nucleic acid tests were extracted from patient records.

Main Results:

  • A significant proportion of discordant HIV test results did not have the recommended HIV nucleic acid test completed.
  • Specifically, 35% of discordant cases lacked the follow-up HIV NAT as recommended by protocols.
  • This indicates a substantial gap between recommended practice and actual clinical execution for HIV diagnostics.

Conclusions:

  • Adherence to recommended HIV nucleic acid testing following discordant immunoassay results is suboptimal at this institution.
  • The findings highlight a critical need to improve the implementation of confirmatory HIV NAT to ensure accurate and timely HIV diagnosis.
  • Systemic improvements or reflexive ordering protocols for HIV NAT may be necessary to address this diagnostic gap.