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SEROLOGY: An HIV-2 EIA was licensed by the FDA in 1990 and became mandatory for screening blood donors in 1992. Western blot patterns that suggest HIV-2 shows an indeterminant band pattern of gag (p66, p51, p32) and absence of env (gp 160, gp 120 and gp 41). Of the FDAapproved rapid tests, OraQuick, Multispot, VITROS and Clearview detect HIV-1 and -2. Reveal G2 and Uni-Gold Recombigen are approved for detection of only HIV-1. For more information see pg 14.
PREVALENCE: There were 79 persons diagnosed with HIV-2 infection in the United States between 1987 and March, 2007; 52 were born in West Africa, and most of the rest had either traveled there, had a sexual partner from that region, or had incomplete data (MMWR 1995;44:603;JAMA1992;267:2775; www.cdc.gov/hiv/resources/factsheets/hiv2.htm (accessed July 1, 2008). The CDC rec ommends that HIV-2 serology be included in serologic testing of 1) natives of endemic areas (see footnote, pg 7), 2) needle-sharing and sex partners of persons from an endemic area, 3) sex partners or needle-sharing partners of persons with HIV-2 infection, 4) persons who received transfusions or nonsterile injec tions in endemic areas and 5) children of women with risk for HIV-2 infection.
HIV Serology
INDICATIONS: Recommendations for HIV testing has been “risk-based” throughout most of the epidemic in The US. Risk-based testing focuses on these populations: 1) Adults in populations with an estimated sero- prevalence >1% (MSM, IDU, commercial sex workers, patients with STDs, TB, contacts or partners with HIV), 2) pregnant women, 3) sexual assault victims, 4) people with occupational exposure, and 5) anyone who requests the test (NEJM 2006;355:647; CID 2004;39:609). However, in 2006 the CDC recommended a change in national policy to advocate “opt out” testing (MMWR 2006; 55:RR 14) based on two concerns: 1) The HIV prevention effort has failed in the US as well as in most of the world; it is estimated that 250,000 (about 25% of all infected people in the US) are unaware of HIV infection. Some studies suggest detection of these 25% would reduce transmission rates by up to 31% based on behavioral change that accompanies knowledge of HIV infection (AIDS 2006; 20:144). Another reason to promote testing concerns is that late entry into care results in reduced benefit from HAART (MMWR 2006; 55:1269). The “optout” strategy is inten- ded to reduce the barriers to testing imposed by a 20 year heritage of “AIDS exceptionalism”which often required signed informed consent and documentation of pre-test/post-test counseling, requirements that some states and many other countries have as standards or laws.This policy still has advocates based on stigma, discrimination, insurance coverage for this as a screening test or the benefit of mandating counseling (Am J Bioethics 2006;6:5; Lancet 2007;369:539).
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