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Lancet. 1992 Dec 19-26;340(8834-8835):1496-9.

Comparison of saliva and serum for HIV surveillance in developing countries.

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Department of Epidemiology, University of California, Los Angeles.


Saliva has been proposed as a non-invasive alternative to serum for HIV antibody testing. In a field study in Myanmar (formerly Burma), we evaluated such an alternative to identify the frequency of HIV infection in a surveillance programme of high-risk and low-risk sentinel groups. Duplicate vials of saliva and serum were collected from 479 high-risk and 1039 low-risk subjects. One vial of each pair was analysed blind in two laboratories, one in the USA and the other in Myanmar. The US laboratory followed WHO confirmatory strategy III with three different enzyme-linked immunosorbent assays (ELISAs), while the laboratory in Myanmar followed strategy I with one ELISA. Serum testing in the US was the gold standard. The Cambridge ELISA with saliva was a more effective surveillance tool (sensitivity 90.5%, specificity 99.5-100%) for describing the frequency of subjects with HIV antibodies than the serum ELISA supplied to Myanmar by WHO (95.9% and 98.3%, respectively). Saliva is recommended as a safe and effective alternative to serum for HIV antibody testing with ELISA in surveillance programmes in developing countries.


HIV infection is becoming increasingly prevalent in Myanmar. More widespread HIV testing is therefore needed to make people aware that HIV has reached their community and convince them that preventive measures must be taken. The expense of blood serum testing, however, generally makes such widespread testing nonviable for developing countries. Testing saliva for the presence of antibodies to HIV has been suggested as a noninvasive alternative to testing serum. In testing saliva, needlestick injuries would be avoided, highly trained personnel would not be needed, many subjects could be sampled simultaneously, subjects might prefer to give saliva samples instead of blood, and costs would be lower. 479 high-risk and 1039 low-risk subjects were recruited for the study from Myanmar. Their saliva and serum samples were then tested in both the US and Myanmar. 3 ELISA tests were used to test serum in the US in keeping with World Health Organization confirmatory strategy III. Only one ELISA was performed in the Myanmar laboratory. The Cambridge ELISA proved most effective in identifying the number of subjects with HIV antibodies. The authors recommend testing saliva instead of serum for HIV surveillance programs in developing countries. Given the Cambridge ELISA 10% false-negative rate in the Myanmar laboratory and the 5% false-negative rate in the US laboratory, saliva testing is, however, inadequate for diagnostic testing and should be used exclusively for surveillance purposes.

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