Uğur Tüzüner*, Begüm Saran Gülcen and Mehmet Özdemir
Necmettin Erbakan University, Meram Medical Faculty, Medical Microbiology Department, Medical Virology Division. Konya, Turkey
Received: 02 April, 2016; Accepted: 18 April, 2016; Published: 19 April, 2016
Dr. Uğur Tüzüner, Necmettin Erbakan University, Meram Medical Faculty, Medical Microbiology Department, Konya, Turkey, Tel:+90 332 223 7029; E-mail:
Tüzüner U, Gülcen BS, Özdemir M (2016) Laboratory Algorithm in HIV Infection Diagnosis. J HIV Clin Sci Res 3(1): 007-010. DOI: 10.17352/2455-3786.000018
© 2016 Tüzüner U, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
HIV; Laboratory diagnosis; Algorithm
AIDS caused by HIV is an infection disease which was defined firstly in the USA in 1981. Since then, number of AIDS patients has increased continuously. About 36.9 million people are living with HIV around the world. Approximately 15 million people living with HIV were receiving antiretroviral therapy. Early detection is important due to the high risk of transmission that precedes seroconversion and also because it provides an opportunity to improve health outcomes with an early antiretroviral therapy. HIV testing is the key part of diagnosis and prevention efforts. Many tests have been used in the diagnosis of HIV over years and with developing testing methods, accuracy of the laboratory diagnosis of HIV infection has been improved. Detecting p24 antigens, HIV 1-2 antibodies and HIV nucleic acid demonstrated that antibody testing alone might miss a considerable percentage of HIV infections detectable by these tests. This review provides updated recommendations and algorithm for HIV testing that are necessary for diagnosing HIV and offers approaches for accurate assessment of test results.
The Human Immunodeficiency Virus (HIV) is a lentivirus, a subgroup of retrovirus, that causes HIV infection and over time Acquired Immunodeficiency Syndrome (AIDS) . HIV targets the immune system and weakens people’s defense systems against opportunistic infections and some types of cancer. As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient . Immune function is typically measured by CD4 cell count. Immunodeficiency results in increased susceptibility to a wide range of infections and diseases that people with healthy immune systems can fight off . Without treatment, average survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype .
AIDS was described for the first time in 1981, by the United States Center for Disease Control (CDC) in a group of the gay men and in immigrants from Haiti as a result of detecting rare Pneumocystis jiroveci pneumonia, and severe mucosal candidiasis in Kaposi’s sarcoma cases [5-9]. The virus was isolated in 1983 by F. Barre-Sinoussi and L. Montagnier at Pasteur Institute in France for the first time . The International Committee on Taxonomy of Viruses has called this virus HIV (human immunodeficiency virus), as it causes severe immunodeficiency leading to AIDS .
Infection with HIV occurs by the transfer of blood, semen, pre-seminal fluid, vaginal fluid and rectal fluids . Within these bodily fluids, HIV is present as both free virus particles and within infected immune cells. Individuals cannot become infected through ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or water . Men who have sex with men, people who inject drugs, sex workers, transgender people and people in prisons and other closed settings are the conditions for inclusion in a high risk population.
There are three stages of HIV infection. The symptoms of HIV vary depending on the stage of infection; acute HIV infection, chronic HIV infection (asymptomatic HIV infection or clinical latency), and progression to AIDS (the late stage of HIV infection). The first few weeks after initial infection, individuals may experience no symptoms or flu-like symptoms that can include: fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes and mouth ulcers. These symptoms can last during a few days to several weeks. The virus attacks and destroys the infection-fighting CD4 cells of the immune system. HIV can be transmitted during any stage of infection, but the risk is greatest during acute HIV infection. During this time, HIV infection may not show up on an HIV test [12,14].
The second stage of HIV infection is chronic HIV infection. During this stage of the disease, HIV continues to multiply in the body but at very low levels. People with chronic HIV infection may not have any HIV-related symptoms. AIDS is the final stage of HIV infection. Because HIV has destroyed the immune system, the body can’t fight off opportunistic infections and cancer. Opportunistic infections can rarely occur during the transient CD4 lymphopenia of early HIV infection . Oral and esophageal candidiasis are the most common opportunistic infections in these patients . Other opportunistic infections that have been reported during acute HIV infection include CMV infection (proctitis, colitis, and hepatitis), Pneumocystis jiroveci pneumonia and prolonged, severe cryptosporidiosis (Figure 1) [17-19].
- Douek DC, Roederer M, Koup RA (2009) Emerging Concepts in the Immunopathogenesis of AIDS. Annu Rev Med 60: 471-484.
- Piot P, Bartos M, Ghys PD, Walker N, Schwartländer B (2001) The global impact of HIV/AIDS. Nature 410: 968-973 .
- Lever AML (2009) HIV: the virus. Medicine 37: 313-316 .
- UNAIDS, WHO (2007) AIDS epidemic update .
- Hymes KB, Cheung T, Greene JB, Prose NS, Marcus A, et al. (1981) Kaposi's sarcoma in homosexual men: A report of eight cases. Lancet 2: 598-600 .
- Gottlieb MS (2006) Pneumocystis pneumonia--Los Angeles. 1981. Am J Public Health 96: 980-981 .
- Centers for Disease Control (CDC) (1981) Follow-up on Kaposi's sarcoma and Pneumocystis pneumonia. MMWR Morb. Mortal. Wkly Rep 30: 409-410.
- Centers for Disease Control (CDC) (1981) Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men--New York City and California. MMWR Morb. Mortal. Wkly Rep 30: 305-308 .
- Centers for Disease Control (CDC) (1981) Pneumocystis pneumonia-Los Angeles. MMWR Morb Mortal. Wkly Rep 30: 250-252 .
- Barré-Sinoussi F, Chermann JC, Rey F, Nugeyre MT, Chamaret S, et al. (1983) Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Science 220: 868-871 .
- Coffin J, Haase A, Levy JA, Montagnier L, Oroszlan S, et al. (1986) What to call the AIDS virus? Nature 321: 10 .
- Card JJ, Amarillas A, Conner A, Akers DD, Solomon J, et al. (2008) The Complete HIV/AIDS Teaching Kit: with CD-ROM, Springer Publishing Company, New York 25-71 .
- Stolley KS, Glass JE (2009) HIV/AIDS. Greenwood Publishing Group, Santa Barbara 9-10 .
- Lewthwaite P, Wilkins E (2009) Natural history of HIV/AIDS. Medicine 37: 333-337 .
- Gupta KK (1993) Acute immunosuppression with HIV seroconversion. N Engl J Med 328: 288-289 .
- Braun DL, Kouyos RD, Balmer B, Grube C, Weber R, et al. (2015) Frequency and Spectrum of Unexpected Clinical Manifestations of Primary HIV-1 Infection. Clin Infect Dis 61: 1013.
- Vento S, Garofano T, Di Perri G, Concia E, Bassetti (1993) Pneumocystis carinii pneumonia during primary HIV-1 infection. Lancet 342: 24-25.
- Moss PJ, Read RC, Kudesia G, McKendrick MW (1995) Prolonged cryptosporidiosis during primary HIV infection. J Infect 30: 51-53 .
- Fanales-Belasio E, Raimondo M, Suligoi B, Buttò S (2010) HIV virology and pathogenetic mechanisms of infection: a brief overview. Ann Ist Super Sanità 46: 5-14 .
- Thompson MA, Aberg JA, Cahn P, Montaner JS, Rizzardini G, et al. (2010) Antiretroviral Treatment of Adult HIV Infection 2010 Recommendations of the International AIDS Society-USA Panel. JAMA 304: 321-333 .
- Smith MK, Rutstein SE, Powers KA, Fidler S, Miller WC, et al. (2012) The detection and management of early HIV infection: a clinical and public health emergency. J Acquir Immune Defic Syndr 63: 187-199 .
- Branson BM, Stekler JD (2012) Detection of acute infection: we can't close the window. J Infect Dis 205: 521-524.
- Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, et al. (2006) Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant women in Health Care Settings. MMWR 55: 1-17.
- Bartlett JG. Screening and diagnostic testing for HIV infection .
- Gillespie SL. Diagnostic testing for HIV infection in infants and children younger than 18 months .
- HIV / AIDS Diagnosis-Treatment Guide. The Ministry of Health Public Health Agency of Turkey.
- Tural C, Ruiz L, Holtzer C, Schapiro J, Viciana P, et al. (2002) Clinical utility of HIV-1 genotyping and expert advice: the Havana trial. AIDS 16: 209-218 .
- Cohen CJ, Hunt S, Sension M, Farthing C, Conant M, et al. (2002) A randomized trial assessing the impact of phenotypic resistance testing on antiretroviral therapy. AIDS 16: 579-588.
- Nasrullah M, Wesolowski LG, Meyer WA, Owen SM, Masciotra S, et al. (2013) Performance of a fourth-generation HIV screening assay and an alternative HIV diagnostic testing algorithm. AIDS 27: 731-737 .
- CDC (2014) Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations .
- Cornett JK, Kirn TJ (2013) Laboratory diagnosis of HIV in adults: a review of current methods. Clin Infect Dis 57: 712-718 .
- Zouhair S, Roussin-Bretagne S, Moreau A, Brunet S, Laperche S, et al. (2006) Group o human immunodeficiency virus type 1 infection that escaped detection in two immmunoassays. J Clin Microbiol 44: 662-665 .
- Sullivan JF, Kessler HA, Sha BE (1993) False-positive HIV test: implications for the patient. JAMA 269: 2847 .
- Erickson CP, McNiff T, Klausner JD (2006) Influenza vaccination and false positive HIV results. N Engl J Med 354: 1422-1423 .
- World Health Organization (2010) WHO Recommendations on the Diagnosis of HIV Infection in Infants and Children .
- Read JS (2007) Diagnosis of HIV-1 Infection in Children Younger Than 18 Months in the United States, Pediatrics 120: 1547-1562 .
Follow us on Academia.edu
Access denied for user 'root'@'localhost' (using password: YES)