Evaluation of Virologic Methods for Early Detection of HIV-1 in a Resource-limited Setting: Performance and Cost Analysis

ABSTRACT

Introduction: Rapid testing and detection of acute HIV infection are two important arms in the prevention of HIV infection. Virologic testing for HIV remains the mainstay for early diagnosis of the infection. Nucleic acid-based testing for HIV however; requires expensive laboratory infrastructure and well-trained personnel; thereby making it not easily accessible in Low- Middle- Income Countries (LMIC). HIV DNA polymerase chain reaction is currently used by few laboratories in many LMIC to detect HIV in children born of HIV-positive mothers before 18 months. Challenges relating to timely result notification can be reduced if the Early Infant Diagnosis (EID) Programme is decentralized and with easy access to laboratory facilities using other tests with high performance characteristics. Methods: We evaluated the performance of five assays to identify HIV antibodies; p24 antigen; proviral DNA or viral RNA in 109 infants born to HIV-positive mothers in Yaounde; Cameroon. Results: The test performance (using plasma) of the HIV p24 antigen ELISA by Perkin Elmer; Roche Amplicor HIV-1 DNA PCR and the Abbott Realtime HIV-1 assay was 100 identifying 12 positive cases. A positive and significant correlation between the HIV-1 RNA viral load and HIV p24 antigen level was found (p0.05). Conclusion: Therefore; HIV p24 antigen detection by ELISA can be used for early diagnosis of HIV and thus recommended for a decentralized EID Programme in LMIC