Laboratory Management

and Screening of HIV

Disease Monitoring
Disease monitoring

 CD4 cell count

 P24 Antigen detection
 β2 Microglobulin
 Neopterin
 Others like
 Soluble IL2 receptor
 IgA
 Endogenous IFN
 TNF-α
CD4 count by Flowcytometry

 3 ml EDTA Tube
 Process immediately, Or within a maximum of 48 hours
 Keep sample at ambient temperature
 Collect sample at similar times of the day to avoid diurnal fluctuations
CD4 count by Flowcytometry
HIV diagnosis in New Born

 > 80% of HIV in infants – acquired perinatally

 Passive transfer of maternal IgG may persist for 15 Mo
 Making distinction between maternal and neonatal IgG may be difficult
 IgA- WB at 3 Mo- 97.6% sensitive, 99.7% specific
 IgM-Produced by 6 Mo- but erratic, false +ve
 P24 Ag estimation
 RT-PCR
National Strategies and algorithms for
HIV testing
Choice of test protocol depends upon-
 Objective of HIV testing
 Sensitivity and specificity of the test used
 The prevalence of the HIV infection among the population
 Resources available
 Appropriateness to the strategy of testing
 Infrastructural facilities available
Objectives of HIV testing

 Assure blood and blood products safety.

 Screen donors of Sperms, Organs and tissues to prevent HIV transmission to
the recipient.
 Diagnosis of HIV infection in clinically suspected individuals.
 Prevention of parent to child transmission after counselling and informed
consent.
 Voluntary testing of high risk groups.
 Sentinel surveillance to monitor epidemiological trends.
 Research, surveys to identify population groups requiring specific
intervention.
Choice of tests

 The first test should be most sensitive

 At least two kits should distinguish HIV 1 from HIV 2
 Combinations as per principle should be
 Immunofiltration+ Immunoassay + Agglutination
 Immunofiltration + Immunoassay + Lateral flow/Immuno chromatography
 Immunofiltration + Agglutination + Lateral flow/Immuno chromatography
 Immunoassay + Agglutination + Lateral flow/Immuno chromatography
 Or they should contain different Antigens
Testing for children
>18 months of age
National AIDS Control Organization

 Comes under the Ministry of Health and Family Welfare

 Most of HIV screening is done at local level i.e. in Integrated Counselling
and testing centers, surveillance and PPCTCs
 Centralized referral laboratories provide reference diagnostic services for
problematic sera and perform sophisticated test like western blot, PCR, etc.
Services performed under NACO in PGI
include
 Pre test counselling
 Diagnosis of HIV according to strategy III after an informed consent
 Post test counselling
 CD 4 counts before commencing ART as well as 6 monthly
 Viral load for patients not responding to ART
 Others:
 Sentinel surveillance
 Quality control
 Training of personnel
 Refresher training courses
 External Quality assurance
External quality assessment scheme

 The assessment of quality in a schematic way through an external agency

using material of known but undisclosed results is called external quality
assessment scheme.
 Considered as powerful tool that challenges the internal quality control
measures being adopted by laboratory.
 Require one well-equipped experienced laboratory at intermediate or
central level to act as organizing laboratory and fairly reasonable number
of laboratories to act as participating laboratories.
 Participating laboratories analyze and send the results of the samples
submitted to them, to the organizing lab which sends feedbacks to the
participants to help them judge their individual performances.