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Nucleic acid testing-optimized HIV diagnostic algorithms: a multimethod comparative effectiveness analysis in
Defu Yuan1,2, Fei Zhao2, Li Li2
1Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, China.
British Journal of Biomedical Science
|August 13, 2026
Summary
Optimizing HIV testing strategies is crucial, as late diagnoses remain high. DNA quantitative testing shows 100% accuracy, improving early detection and AIDS control efforts.
Area of Science:
- Infectious Diseases
- Diagnostic Technologies
- Public Health
Background:
- Significant gaps persist in achieving global HIV testing targets, leading to high rates of late diagnosis.
- Current HIV testing strategies require optimization to improve early detection and patient outcomes.
- Late HIV diagnosis poses a substantial challenge to effective public health interventions and AIDS control.
Purpose of the Study:
- To evaluate and compare the diagnostic performance of RNA/DNA quantification, RNA qualitative, and ELISA assays for HIV testing.
- To identify optimal HIV testing strategies, including tandem testing approaches, to enhance sensitivity and specificity.
- To address challenges in HIV diagnosis, such as ART-induced RNA suppression and Western blot-indeterminate results.
Main Methods:
- A prospective cross-sectional study involving 215 first-time HIV testers was conducted.
- Four diagnostic methods (DNA quantitative, RNA quantitative, RNA qualitative, ELISA) were assessed against clinical diagnosis as the reference standard.
- Receiver Operating Characteristic (ROC) analysis and tandem testing strategy simulations were employed to evaluate diagnostic performance.
Main Results:
- DNA quantitative detection achieved 100% sensitivity and specificity, with an AUC of 1.000.
- RNA quantitative assay demonstrated 99.02% sensitivity and 100% specificity (AUC = 0.995).
- An optimal tandem strategy combining ELISA screening with DNA quantitative confirmation yielded 99.02% sensitivity and 100% specificity.
Conclusions:
- DNA quantitative detection offers high diagnostic value for initial HIV testing, effectively addressing challenges like ART-induced RNA suppression.
- Integrating nucleic acid tests into diagnostic algorithms and utilizing ELISA followed by DNA confirmation can shorten diagnostic delays.
- Optimized HIV testing strategies are essential for reducing late diagnoses and advancing national AIDS control objectives.
