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Press Start: Lead an Empowered Life as a Clinical Laboratorian

APHL Asks For Help With HIV Algorithms

Published September 16, 2009 5:24 PM by Glen McDaniel
 Back in 1989, the Centers for Disease Control and Prevention (CDC) and the Association of Public Health Laboratories (APHL) issued a firm algorithm for diagnosing HIV; an algorithm that is still in use today as the gold standard.

The patient is tested with a preliminary enzyme immunoassay (EIA) screening test. If the result is repeatedly reactive, the patient result is listed as "preliminary positive"  and a blood specimen is further tested by a more specific test such as the Western Blot or an indirect immunofluorescence assay (IFA).

If the preliminary EIA test is negative, the patient is presumed to be  negative, with no further testing needed.

Over the years, rapid tests have become more specific, sensitive and less complex.  An oral specimen is now acceptable for some tests.

Public health authorities are encouraging that many more people get tested; not just those from the old so called "high risk groups." Tests therefore need to be accurate and fast and done in a way that will minimize hassle for patients, e.g. not requiring everyone to return for their results, or using 2 different EIA tests to produce a definitive result.

APHL issued the following release recently:

"The Association of Public Health Laboratories (APHL) has published 'HIV Testing Algorithms: A Status Report,' in collaboration with the Centers for Disease Control and Prevention. The report presents newly-proposed HIV testing strategies for both point-of-care and laboratory settings. The document's purpose is to facilitate the dissemination, evaluation and discussion of these alternative testing algorithms." You may read the executive summary here.

The release continues,  " Data are requested from any laboratory using alternative HIV testing algorithms or evaluating the performance of multiple HIV tests. These data will be used to evaluate the performance of these alternative algorithms and, eventually, lead to the development of improved guidelines for HIV testing. Specific data needs are outlined in the report. To submit data, complete the data questionnaire or contact"



I thought the testing was pretty much set. It seems to be working for us in the lab for years. After reading the article I still dont know why they feel they should change it. In the lab we do a screening test for many things like sickle, syphilis and then we do a more specific test.

In our lab the doctor orders "HIV" we do the rapid screening ELISA 10 minute test and report it out as negative or positive- and then automatically send the same positive specimen out to our reference lab for Western Blot.

Maybe I am missing the point of these new standards. Dont get me wrong I am in favor of making the HIV test simpler and more available. HIV is not a joke and is growing again in Atlanta after decreasing for awhile. One lab I worked at does testing for the jails and we used to get positives out of there all the time. So those guys might not have been tested if they were not in jail and  I know they are spreading it among themselves in there.

Another issue is that the young people dont personally know anyone who suffered terribly as they died form AIDS so they think HIV is a phantom disease or just like gonorrhea for which you can just take a pill.

So the bottom line I guess is if we can come up with a quicker system that will  encouraging testing more people, and end up diagnosing more people faster then it's all good.

Jonathan MLS(ASCP) September 19, 2009 1:00 PM
Atlanta GA

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