The Physician's Guide to Laboratory Test Selection and Interpretation
Human immunodeficiency virus 1 (HIV-1) is thought to have originated as a zoonotic transmission from simian immunodeficiency virus (SIV)-infected primates, while human immunodeficiency virus 2 (HIV-2) is thought to have originated as a zoonotic transmission from Sooty Mangabeys.
Epidemiology
Organism
Pathophysiology
Clinical Presentation
Prevention
| Test Name and Number | Recommended Use | Limitations | Follow Up |
|---|---|---|---|
| Human Immunodeficiency Virus 1,2 Combined Antibodies with Reflex to HIV-1 Confirmation by Western Blot 0051160 Method: Enzyme Immunoassay/Western Blot |
Screen for presence of HIV infection Screen for antibodies against HIV-1 and HIV-2 |
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| Human Immunodeficiency Virus 1 Antibody, Confirmation 0020284 Method: Western Blot |
Confirmation after positive rapid point of care test If screening test is repeatedly reactive, the laboratory automatically performs Western Blot |
Do not use for blood donor screening, associated re-entry protocols or for screening human cell, cellular and tissue-based products (HCT/P) |
|
| Lymphocyte Subset Panel 1 - CD4 Absolute Count Only 0095854 Method: Flow Cytometry |
Monitor treatment efficacy Determine T-cell (CD4) levels to establish decision points for initiating P. jiroveci prophylaxis, antiviral therapy Order concurrently with HIV viral load monitoring tests |
Other lymphocyte panels are available; see list of additional tests available |
|
| Human Immunodeficiency Virus 1, Genotyping 0055670 Method: Reverse Transcription Polymerase Chain Reaction/DNA Sequencing |
Detect changes in the viral genome that are associated with drug resistance Use in conjunction with CD4 measurement to monitor treatment efficacy Test requires specimens with HIV-1 RNA plasma levels of >1,000 copies/mL |
Treatment failure can be caused by factors other than drug resistance; therefore, the interpretation of resistance genotyping results must be done in conjunction with other clinical and laboratory information Comparisons between assays performed in different laboratories are not recommended since no method standardization exists among HIV-1 drug resistance testing Results from different test methods/algorithms may provide different resistance interpretation Absence of resistance mutations does not rule out the presence of reservoirs of resistant viruses that cannot be detected by these tests Some specimens with HIV-1 RNA plasma levels >1,000 copies/mL may not provide adequate data due to polymorphisms in the priming areas of genome Test does not detect HIV-1 populations that are less than approximately 20% of the total population |
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| Human Immunodeficiency Virus 1 RNA Quantitative Real-Time PCR 0055598 Method: Real-Time Polymerase Chain Reaction |
Use in conjunction with clinical presentation as indicator of disease prognosis Use as aid in assessing viral response to antiretroviral treatment |
An interpretation of "Not Detected" does not rule out the presence of inhibitors in the patient specimen or HIV-1 virus RNA concentrations below the level of detection of the assay |
|
| Human Immunodeficiency Virus 1 RNA Quantitative bDNA 0020466 Method: Branched Chain DNA |
Use with clinical presentation as indicator of disease prognosis Use as aid in assessing viral response to antiretroviral treatment |
An interpretation of "Not Detected" does not rule out the presence of inhibitors in the patient specimen or HIV-1 virus RNA concentrations below the level of detection of the assay; low positive values may occasionally be seen in specimens from patients who are uninfected |
|
| Human Immunodeficiency Virus 1 DNA PCR, Qualitative 0093061 Method: Polymerase Chain Reaction |
Detects HIV-1 proviral DNA in infants (before 48 hours, 1-2 months and 3-6 months of age) |
Do not use umbilical cord blood due to contamination with mother’s blood |
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| Human Immunodeficiency Virus 2 Antibody with Reflex to Confirmation 0051250 Method: Enzyme Immunoassay/Immunoblot |
Screen for presence of HIV-2 infection in patient with epidemiologic link to Africa |
Repeatedly reactive EIA results will be confirmed by immunoblot |
Click the plus sign to expand the table of additional tests.
| Test Name and Number | Comments |
|---|---|
| Human Immunodeficiency Virus 2 Antibody Confirmation by Immunoblot 0093272 Method: Immunoblot |
Confirm positive screening results |
| Human Immunodeficiency Virus 1 Antibody with Reflex to Confirmation by Western Blot 0051154 Method: Enzyme Immunoassay/Western Blot |
Screen for presence of HIV-1 infection |
| Human Immunodeficiency Virus1 RNA Quantitative Real-Time PCR with Reflex to Genotyping 0051660 Method: Real-Time Polymerase Chain Reaction |
Panel test Use with clinical presentation as an indicator of disease prognosis and assess viral response to antiretroviral treatment |
| Human Immunodeficiency Virus 1 RNA Quantitative bDNA with Reflex to Human Immunodeficiency Virus 1 Genotyping 0051664 Method: Branched Chain DNA/Genotyping |
Panel test Use with clinical presentation as an indicator of disease prognosis and assess viral response to antiretroviral treatment |
| Lymphocyte Subset Panel 2 - CD4 Percent & Absolute 0095885 Method: Flow Cytometry |
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| Lymphocyte Subset Panel 3 - T-Cell Subsets (CD4 & CD8), Absolute Counts Only 0095853 Method: Flow Cytometry |
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| Lymphocyte Subset Panel 4 - T-Cell Subsets Percent & Absolute, Whole Blood 0095950 Method: Flow Cytometry |
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| Lymphocyte Subset Panel 5 - Total Lymphocyte Enumeration 0095892 Method: Flow Cytometry |
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| Lymphocyte Subset Panel 6 - Total Lymphocyte Enumeration with CD45RA & CD45RO 0095862 Method: Flow Cytometry |
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| Erythropoietin 0050227 Method: Chemiluminescent Immunoassay |
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| HLA-B*5701 Genotyping 2002429 Method: Polymerase Chain Reaction/Fluorescence Monitoring |
Determine susceptibility to Abacavir hypersensitivity |