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Human immunodeficiency virus: Diagnostic approach
1Department of Pathology and Laboratory Medicine, Emory University, 1364, USA Clifton Rd, Atlanta, GA 30322, USA.
Insights
This review details the evolution of human immunodeficiency virus (HIV) diagnostic tests and algorithms since the 1980s. Current methods, including fourth-generation immunoassays and nucleic acid testing, enable early detection of acute HIV infections.
Area of Science:
- Infectious Diseases
- Virology
- Clinical Diagnostics
Background:
- The first descriptions of acquired immunodeficiency syndrome (AIDS) emerged in 1981.
- The causative agent of HIV was cultured four years later, paving the way for diagnostic test development.
- Early diagnostic approaches have evolved significantly since the initial identification of HIV.
Purpose of the Study:
- To review the historical progression of HIV testing technologies and diagnostic algorithms.
- To describe the current state of HIV diagnosis, including advanced immunoassays and nucleic acid testing.
- To discuss specialized considerations in HIV diagnosis and evolving public health strategies.
Main Methods:
- Review of historical medical literature and public health guidelines related to HIV diagnostics.
- Analysis of the development and implementation of successive generations of HIV immunoassays.
- Examination of current diagnostic algorithms recommended by organizations like the CDC and WHO.
Main Results:
- Fourth-generation immunoassays, detecting p24 antigen and antibodies, are now standard for initial HIV screening.
- Confirmatory testing has shifted from Western blot to differentiation assays and nucleic acid testing (NAT) for HIV-1.
- Current algorithms facilitate the detection of acute HIV infections, improving timely intervention.
- World Health Organization protocols incorporate rapid testing for widespread HIV diagnosis.
Conclusions:
- The evolution of HIV diagnostics has led to more sensitive and specific testing strategies.
- Modern algorithms, incorporating fourth-generation assays and NAT, are crucial for early HIV detection and management.
- Continued advancements in diagnostic technology and algorithms are vital for global HIV control efforts.
Abstract:
First descriptions of acquired immunodeficiency syndrome appeared in 1981. Four years later the causative agent was cultured which lead to development and production of tests that helped healthcare providers to identify persons living with HIV. Currently, diagnosis of HIV is performed with fourth generation immunoassays (those that detect p24 antigen together with IgM and IgG antibodies to HIV-1 and -2) which if positive need to be followed by an assay that can differentiate between HIV-1 and HIV-2 viruses. The Western blot is no longer used to confirm HIV infections per CDC guidelines. In case there is a positive fourth generation assay but negative differentiation assay, nucleic acid testing for HIV-1 should be performed. This algorithm allows for detection of acute infections. Alternatively, the World Health Organization has algorithms that use rapid testing for diagnosis of HIV infections. This review will describe the evolution of tests and diagnostic algorithms from the 1980s to the current state. Special situations regarding diagnosis will also be discussed.
