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In-house HIV tests accelerate results
Hospitals that use an on-site HIV-1/HIV-2 differentiation test may receive their results faster than centers who use reference laboratories for their testing, according to recent research.
Laura G. Wesolowski, PhD, from the CDC’s Division of HIV/AIDS Prevention, and colleagues evaluated HIV testing using fourth-generation antigen/antibody immunoassay (4IA), supplemental antibody testing and [nucleic acid tests (NATs)] at three different medical centers: Massachusetts General Hospital (MGH), the Medical University of South Carolina (MUSC) and Harborview Medical Center (HMC). At MGH and MUSC, HIV-1 Western blot and HIV-2 tests were conducted at a laboratory, the researchers said.
Wesolowski and colleagues compared the time from specimen collection to laboratory result for both established and acute infections, and calculated the cost for each positive test result. An individual is considered to have an established infection when an initial screening test and an antibody supplemental test are both positive.
Overall, MGH tested 19,774 specimens, while HMC and MUSC tested 14,511 and 3,731 specimens, respectively. The prevalence of established infections was less than 1% across all three hospitals. There was a range in the proportion of acute infections — from 0.01% at MGH to 0.05% at HMC — which consisted of 5.9% of HIV-1 infections at MUSC, 5.6% at HMC and 1.6% at MGH.
“There were four specimens from MGH, three from MUSC, and two from Harborview with a repeatedly reactive immunoassay and negative or indeterminate Western blot that did not have an HIV-1 NAT result,” Wesolowski and colleagues wrote. “It is not known whether these would represent false-positive fourth-generation results or acute infections.”
Time to result for acute infections ranged from 1.5 days at HMC, which conducted in-house testing, to 5.2 days at MGH, while time to result for established infections ranged from 1 day at HMC to 5.2 days at MGH, according to the researchers. Wesolowski and colleagues noted that laboratory cost per infection was lowest at MGH at $1,054 and highest at MUSC, at $1,521.
“Fourth-generation assays identified acute infections in all hospitals,” the researchers wrote. “With the use of these assays, there is a need to expedite the provision of results, since persons with acute infection can be highly infectious.” – by Jeff Craven
Disclosure: Wesolowski reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.