A rapid review of rapid HIV antibody tests

Greenwald, Jeffrey L.; Burstein, Gale R.; Pincus, Jonathan M.; Branson, Bernard M.

doi:10.1007/s11908-006-0008-6

Cited by 174 publications

(119 citation statements)

References 15 publications

(12 reference statements)

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“…Rapid HIV-1 antibody tests are comparable to ELISAs in both sensitivity (99.3%-100%) and specificity (98.6%-100%). 34 They require no special instrumentation outside of the test kit, and results can be available in as little as 20 to 30 minutes. Some of these kits are licensed for point-of-care testing so that clinics without extensive laboratory facilities (but that meet state and federal standards and have appropriately trained personnel) can perform the tests on-site and report the result to the patient immediately.…”

Section: Detection Of Hiv-1 Antibodiesmentioning

confidence: 99%

Diagnosis of HIV-1 Infection in Children Younger Than 18 Months in the United States

Read¹

2007

Pediatrics

118

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The objectives of this technical report are to describe methods of diagnosis of HIV-1 infection in children younger than 18 months in the United States and to review important issues that must be considered by clinicians who care for infants and young children born to HIV-1–infected women. Appropriate HIV-1 diagnostic testing for infants and children younger than 18 months differs from that for older children, adolescents, and adults because of passively transferred maternal HIV-1 antibodies, which may be detectable in the child's bloodstream until 18 months of age. Therefore, routine serologic testing of these infants and young children is generally only informative before the age of 18 months if the test result is negative. Virologic assays, including HIV-1 DNA or RNA assays, represent the gold standard for diagnostic testing of infants and children younger than 18 months. With such testing, the diagnosis of HIV-1 infection (as well as the presumptive exclusion of HIV-1 infection) can be established within the first several weeks of life among nonbreastfed infants. Important factors that must be considered when selecting HIV-1 diagnostic assays for pediatric patients and when choosing the timing of such assays include the age of the child, potential timing of infection of the child, whether the infection status of the child's mother is known or unknown, the antiretroviral exposure history of the mother and of the child, and characteristics of the virus. If the mother's HIV-1 serostatus is unknown, rapid HIV-1 antibody testing of the newborn infant to identify HIV-1 exposure is essential so that antiretroviral prophylaxis can be initiated within the first 12 hours of life if test results are positive. For HIV-1–exposed infants (identified by positive maternal test results or positive antibody results for the infant shortly after birth), it has been recommended that diagnostic testing with HIV-1 DNA or RNA assays be performed within the first 14 days of life, at 1 to 2 months of age, and at 3 to 6 months of age. If any of these test results are positive, repeat testing is recommended to confirm the diagnosis of HIV-1 infection. A diagnosis of HIV-1 infection can be made on the basis of 2 positive HIV-1 DNA or RNA assay results. In nonbreastfeeding children younger than 18 months with no positive HIV-1 virologic test results, presumptive exclusion of HIV-1 infection can be based on 2 negative virologic test results (1 obtained at ≥2 weeks and 1 obtained at ≥4 weeks of age); 1 negative virologic test result obtained at ≥8 weeks of age; or 1 negative HIV-1 antibody test result obtained at ≥6 months of age. Alternatively, presumptive exclusion of HIV-1 infection can be based on 1 positive HIV-1 virologic test with at least 2 subsequent negative virologic test results (at least 1 of which is performed at ≥8 weeks of age) or negative HIV-1 antibody test results (at least 1 of which is performed at ≥6 months of age). Definitive exclusion of HIV-1 infection is based on 2 negative virologic test results, 1 obtained at ≥1 month of age and 1 obtained at ≥4 months of age, or 2 negative HIV-1 antibody test results from separate specimens obtained at ≥6 months of age. For both presumptive and definitive exclusion of infection, the child should have no other laboratory (eg, no positive virologic test results) or clinical (eg, no AIDS-defining conditions) evidence of HIV-1 infection. Many clinicians confirm the absence of HIV-1 infection with a negative HIV-1 antibody assay result at 12 to 18 months of age. For breastfeeding infants, a similar testing algorithm can be followed, with timing of testing starting from the date of complete cessation of breastfeeding instead of the date of birth.

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Section: Detection Of Hiv-1 Antibodiesmentioning

confidence: 99%

Diagnosis of HIV-1 Infection in Children Younger Than 18 Months in the United States

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2007

Pediatrics

118

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“…Although, the majority of these rapid tests utilize whole blood, plasma and finger stick blood specimens, a few tests employ nonconventional specimens, such as saliva, oral mucosal fluid and urine [4,5]. Oral fluid-based rapid tests have potential advantages over blood-based rapid tests because of their convenience, noninvasiveness, ease of specimen collection, cultural acceptance, high accuracy and rapidity [4,[6][7][8].…”

Section: Rapid Point-of-care Hiv Tests and Use Of Nonconventional Specimentioning

confidence: 99%

Oral fluid-based rapid HIV testing: issues, challenges and research directions

Pai¹

2007

Expert Review of Molecular Diagnostics

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“…2 In recent years, lack of identification of maternal HIV-infection status has been the primary reason for new infant HIV infections; effective interventions cannot be implemented unless maternal HIV status is known. Rapid HIV antibody testing methods now allow identification of HIV-infected women or HIV-exposed infants in 20 to 60 minutes [3][4][5] (see also www.cdc.gov/ hiv/topics/testing/rapid/index.htm). Studies have demonstrated the effectiveness of ARV prophylaxis for preventing MTCT of HIV, even when prophylaxis is initiated after the birth of the infant.…”

Section: Why Is a New Statement Needed Now?mentioning

confidence: 99%

“…3,5,14 These are screening tests, which means that a positive test result requires confirmation with an IFA or Western blot assay. The rapid antibody test is more sensitive and more specific than the conventional EIA, so a conventional EIA is not used as the confirmatory test for a rapid HIV antibody test.…”

Section: Hiv Testingmentioning

confidence: 99%

HIV Testing and Prophylaxis to Prevent Mother-to-Child Transmission in the United States

2008

Pediatrics

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Universal HIV testing of pregnant women in the United States is the key to prevention of mother-to-child transmission of HIV. Repeat testing in the third trimester and rapid HIV testing at labor and delivery are additional strategies to further reduce the rate of perinatal HIV transmission. Prevention of mother-to-child transmission of HIV is most effective when antiretroviral drugs are received by the mother during her pregnancy and continued through delivery and then administered to the infant after birth. Antiretroviral drugs are effective in reducing the risk of mother-to-child transmission of HIV even when prophylaxis is started for the infant soon after birth. New rapid testing methods allow identification of HIV-infected women or HIV-exposed infants in 20 to 60 minutes. The American Academy of Pediatrics recommends documented, routine HIV testing for all pregnant women in the United States after notifying the patient that testing will be performed, unless the patient declines HIV testing (“opt-out” consent or “right of refusal”). For women in labor with undocumented HIV-infection status during the current pregnancy, immediate maternal HIV testing with opt-out consent, using a rapid HIV antibody test, is recommended. Positive HIV antibody screening test results should be confirmed with immunofluorescent antibody or Western blot assay. For women with a positive rapid HIV antibody test result, antiretroviral prophylaxis should be administered promptly to the mother and newborn infant on the basis of the positive result of the rapid antibody test without waiting for results of confirmatory HIV testing. If the confirmatory test result is negative, then prophylaxis should be discontinued. For a newborn infant whose mother's HIV serostatus is unknown, the health care professional should perform rapid HIV antibody testing on the mother or on the newborn infant, with results reported to the health care professional no later than 12 hours after the infant's birth. If the rapid HIV antibody test result is positive, antiretroviral prophylaxis should be instituted as soon as possible after birth but certainly by 12 hours after delivery, pending completion of confirmatory HIV testing. The mother should be counseled not to breastfeed the infant. Assistance with immediate initiation of hand and pump expression to stimulate milk production should be offered to the mother, given the possibility that the confirmatory test result may be negative. If the confirmatory test result is negative, then prophylaxis should be stopped and breastfeeding may be initiated. If the confirmatory test result is positive, infants should receive antiretroviral prophylaxis for 6 weeks after birth, and the mother should not breastfeed the infant.

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A rapid review of rapid HIV antibody tests

Cited by 174 publications

References 15 publications

Diagnosis of HIV-1 Infection in Children Younger Than 18 Months in the United States

Diagnosis of HIV-1 Infection in Children Younger Than 18 Months in the United States

Oral fluid-based rapid HIV testing: issues, challenges and research directions

HIV Testing and Prophylaxis to Prevent Mother-to-Child Transmission in the United States

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