Clinical manifestations of HIV infection in Melanesian adults

@#PIP: By mid-1995, a total of 308 HIV cases had been reported in Papua New Guinea. The majority (74%) of these cases were diagnosed in Port Moresby. This article describes the clinical characteristics of HIV infection in 67 adults who presented to Port Moresby General Hospital in 1990-95. The median age at presentation was 27 years in men and 28 years in women, with an equal distribution of cases by sex. The major presenting symptoms were wasting and weight loss exceeding 10% of body weight (94%), chronic diarrhea (47%), prolonged fever (77%), and oropharyngeal candidiasis (66%). Pulmonary tuberculosis was diagnosed on the basis of chest X-ray and history in 37 patients (56%), but only 3 had sputum positive for acid-fast bacilli. Anemia was present in 75%. 65 patients (97%) fulfilled the World Health Organization criteria for AIDS. The inpatient mortality rate in this series was 43%, and 13 of these 29 patients died within a month of their first presentation.

Laboratory diagnosis of HIV infection in Papua New Guinea

@#In Papua New Guinea, the laboratory diagnosis of HIV infection is based on proof of HIV antibody in the patient's serum. Under the government scheme, the testing is done in 30 laboratories, including the Papua New Guinea HIV Reference Laboratory (NRL), the Red Cross Blood Transfusion Service in Port Moresby, and 19 provincial and 9 district laboratories. An alternative testing strategy was adopted in 1993 based on a WHO recommendation, replacing the classical testing strategy (enzyme immunoassay + Western blot). The alternative testing strategy uses several EIA, rapid or simple HIV antibody assays for the detection and confirmation of the HIV antibody. This approach is faster and cheaper, with the same sensitivity and specificity as the classical testing algorithm. Except for the NRL, the Serodia Fujirebio HIV-1 gelatin particle agglutination assay is used throughout the country as the screening test. The PNG National HIV Reference Laboratory is the only laboratory authorized to perform confirmatory testing and to release positive results. Therefore, all serum samples reactive in the screening assay are sent to the NRL for confirmation by the battery of EIA, rapid or simple assays in accordance with the alternative testing strategy adopted. The paper explains the alternative testing strategy and highlights the principle of each individual test that is employed. PIP: In Papua New Guinea, HIV antibody testing is performed in 19 provincial and 9 district laboratories, the HIV National Reference Laboratory, and the Port Moresby Red Cross Blood Transfusion Service. Before 1993, enzyme immunoassay and Western blot were used for HIV serotesting and positive findings were sent to Australia for confirmation. Since 1993, the Serodia Fujirebio HIV gelatin particle agglutination assay has been used as the first screening test, followed by the enzyme-linked immunosorbent assay; the third test used for repeatedly reactive samples is generally the Immunocomb. All repeatedly positive results are forwarded to the reference laboratory for confirmation. Results are available within 7 days. In Papua New Guinea, the specificity of the Serodia Fujirebio test is consistently greater than 99%.