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Bull World Health Organ. 1994;72(1):129-34.

Strategies for laboratory HIV testing: an examination of alternative approaches not requiring Western blot.

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Evaluation Unit, WHO Global Programme on AIDS, Geneva, Switzerland.


Advances in laboratory tests for antibodies to human immunodeficiency virus (HIV) have permitted the development of alternative HIV testing strategies that do not require use of the Western blot approach. Three strategies are proposed. In strategy I, sera are tested for HIV antibody using an enzyme-linked immunosorbent assay (ELISA)/rapid/simple (ERS) test; in strategy II, sera reactive in an initial ERS test are retested using a second ERS test; strategy III involves retesting with a third ERS test all sera reactive in two previous ERS tests. Where the objective is identification of asymptomatic HIV-infected individuals, strategy III is proposed where HIV prevalences in the study population are < or = 10%, and strategy II at prevalences > 10%. Strategy II is recommended where the diagnosis of HIV-related disease requires HIV testing. For serosurveillance, strategy II is recommended if the prevalence is < or = 10%, and strategy I if the prevalences are > 10%. Use of strategy I is recommended for transfusion and transplantation safety, at any prevalence. Lower-cost laboratory HIV testing will permit such testing to become more widely available.


Testing of sera for antibodies to HIV typically involves screening with enzyme-linked immunosorbent assays (ELISA) and subsequent confirmation with Western blot (WB). Western blot testing, however, is relatively expensive and technically demanding. Recent technological advances have produced tests which provide results equivalent in accuracy to those obtained by WB. These include new ELISA tests, simple tests, and rapid tests. Simple tests are those which are easily learned and require no additional equipment or instrumentation, while rapid tests yield results in 30 minutes or less. The lower cost of these methods will allow HIV testing to become more widely available. The authors propose alternative laboratory HIV testing strategies based upon these newer ELISA/rapid/simple tests (ERS). Strategy 1 tests sera for HIV antibody using ERS tests. Strategy 2 retests sera reactive to initial ERS, and strategy 3 simply retests reactive sera a third time with ERS tests. Strategy 1 is recommended for transfusion and transplantation safety at any prevalence of HIV infection is selected populations. Strategy 1 is also recommended for serosurveillance in study populations where the prevalence of HIV infection is greater than 10%, but strategy 2 is recommend where prevalence are less than or equal to 10%. Strategy 2 is generally recommended when diagnosis of HIV-related disease requires HIV testing. Finally, strategy 3 is proposed to identify asymptomatic HIV-infected individuals where HIV prevalence in the study population are less than or equal to 10%, but strategy 2 will suffice where prevalence are greater than 10%.

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