title: Alternative algorithms for human immunodeficiency virus infection diagnosis using tests that are licensed in the United States.
abstract: Serodiagnosis of human immunodeficiency virus (HIV) infection in the United States has traditionally relied on a sequential two-test algorithm: an initial screen with an enzyme immunoassay (EIA) and reflex testing of EIA-reactive specimens with a more specific supplemental test such as Western blotting or immunofluorescence. The supplemental tests are tedious, subjective, and expensive. In addition, there have been major improvements in the performance and accuracy of the EIA tests as well as the introduction of rapid serologic tests (RT) and HIV nucleic acid amplification tests (NAAT). Related to these improvements is the possibility that alternative algorithms using combinations of currently approved HIV tests may function as well as if not better than the current algorithm, with more flexibility, improved accuracy, and lower cost. To this end, we evaluated the performance of 12 currently licensed tests and 1 in-house HIV test (6 EIA, 4 RT, and 3 NAAT) on panels of plasma samples from HIV-infected (n = 621 HIV type 1 [HIV-1] and 34 HIV-2) and uninfected (n = 513) people and of sequential specimens from people early in seroconversion (183 specimens from 15 patients). Test combinations were analyzed in two dual-test (sensitivity-optimized and specificity-optimized) algorithms and in a three-test (tie-breaking) algorithm, and performance was compared to the conventional algorithm. The results indicate that alternative algorithm strategies with currently licensed tests compare favorably with the conventional algorithm in detecting and confirming established HIV infection. Furthermore, there was a lower frequency of discordant or indeterminate results that require follow-up testing, and there was improved detection of early infection.
authors.affiliation: HIV Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. smo2@cdc.gov
authors.forename: S M
authors.initials: SM
authors.lastname: Owen
authors.forename: C
authors.initials: C
authors.lastname: Yang
authors.forename: T
authors.initials: T
authors.lastname: Spira
authors.forename: C Y
authors.initials: CY
authors.lastname: Ou
authors.forename: C P
authors.initials: CP
authors.lastname: Pau
authors.forename: B S
authors.initials: BS
authors.lastname: Parekh
authors.forename: D
authors.initials: D
authors.lastname: Candal
authors.forename: D
authors.initials: D
authors.lastname: Kuehl
authors.forename: M S
authors.initials: MS
authors.lastname: Kennedy
authors.forename: D
authors.initials: D
authors.lastname: Rudolph
authors.forename: W
authors.initials: W
authors.lastname: Luo
authors.forename: N
authors.initials: N
authors.lastname: Delatorre
authors.forename: S
authors.initials: S
authors.lastname: Masciotra
authors.forename: M L
authors.initials: ML
authors.lastname: Kalish
authors.forename: F
authors.initials: F
authors.lastname: Cowart
authors.forename: T
authors.initials: T
authors.lastname: Barnett
authors.forename: R
authors.initials: R
authors.lastname: Lal
authors.forename: J S
authors.initials: JS
authors.lastname: McDougal
mesh_terms: D000465:Algorithms; D000914:Antibodies, Viral / Q000097:blood; D006678:HIV / Q000235:genetics* / Q000276:immunology*; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D007118:Immunoassay / Q000379:methods*; D021141:Nucleic Acid Amplification Techniques / Q000379:methods*; D010949:Plasma / Q000276:immunology / Q000821:virology; D012367:RNA, Viral / Q000097:blood; D012680:Sensitivity and Specificity; D014481:United States
chemical_list: D000914:Antibodies, Viral; D012367:RNA, Viral