Uğur Tüzüner*, Begüm Saran Gülcen and Mehmet Özdemir
Necmettin Erbakan University, Meram Medical Faculty, Medical Microbiology Department, Medical Virology Division. Konya, Turkey
Received: 02 April, 2016; Accepted: 18 April, 2016; Published: 19 April, 2016
Dr. Uğur Tüzüner, Necmettin Erbakan University, Meram Medical Faculty, Medical Microbiology Department, Konya, Turkey, Tel:+90 332 223 7029; E-mail:
Tüzüner U, Gülcen BS, Özdemir M (2016) Laboratory Algorithm in HIV Infection Diagnosis. J HIV Clin Sci Res 3(1): 007-010. DOI: 10.17352/2455-3786.000018
© 2016 Tüzüner U, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
HIV; Laboratory diagnosis; Algorithm
AIDS caused by HIV is an infection disease which was defined firstly in the USA in 1981. Since then, number of AIDS patients has increased continuously. About 36.9 million people are living with HIV around the world. Approximately 15 million people living with HIV were receiving antiretroviral therapy. Early detection is important due to the high risk of transmission that precedes seroconversion and also because it provides an opportunity to improve health outcomes with an early antiretroviral therapy. HIV testing is the key part of diagnosis and prevention efforts. Many tests have been used in the diagnosis of HIV over years and with developing testing methods, accuracy of the laboratory diagnosis of HIV infection has been improved. Detecting p24 antigens, HIV 1-2 antibodies and HIV nucleic acid demonstrated that antibody testing alone might miss a considerable percentage of HIV infections detectable by these tests. This review provides updated recommendations and algorithm for HIV testing that are necessary for diagnosing HIV and offers approaches for accurate assessment of test results.
The Human Immunodeficiency Virus (HIV) is a lentivirus, a subgroup of retrovirus, that causes HIV infection and over time Acquired Immunodeficiency Syndrome (AIDS) . HIV targets the immune system and weakens people’s defense systems against opportunistic infections and some types of cancer. As the virus destroys and impairs the function of immune cells, infected individuals gradually become immunodeficient . Immune function is typically measured by CD4 cell count. Immunodeficiency results in increased susceptibility to a wide range of infections and diseases that people with healthy immune systems can fight off . Without treatment, average survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype .
AIDS was described for the first time in 1981, by the United States Center for Disease Control (CDC) in a group of the gay men and in immigrants from Haiti as a result of detecting rare Pneumocystis jiroveci pneumonia, and severe mucosal candidiasis in Kaposi’s sarcoma cases [5-9]. The virus was isolated in 1983 by F. Barre-Sinoussi and L. Montagnier at Pasteur Institute in France for the first time . The International Committee on Taxonomy of Viruses has called this virus HIV (human immunodeficiency virus), as it causes severe immunodeficiency leading to AIDS .
Infection with HIV occurs by the transfer of blood, semen, pre-seminal fluid, vaginal fluid and rectal fluids . Within these bodily fluids, HIV is present as both free virus particles and within infected immune cells. Individuals cannot become infected through ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing personal objects, food or water . Men who have sex with men, people who inject drugs, sex workers, transgender people and people in prisons and other closed settings are the conditions for inclusion in a high risk population.
There are three stages of HIV infection. The symptoms of HIV vary depending on the stage of infection; acute HIV infection, chronic HIV infection (asymptomatic HIV infection or clinical latency), and progression to AIDS (the late stage of HIV infection). The first few weeks after initial infection, individuals may experience no symptoms or flu-like symptoms that can include: fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes and mouth ulcers. These symptoms can last during a few days to several weeks. The virus attacks and destroys the infection-fighting CD4 cells of the immune system. HIV can be transmitted during any stage of infection, but the risk is greatest during acute HIV infection. During this time, HIV infection may not show up on an HIV test [12,14].
The second stage of HIV infection is chronic HIV infection. During this stage of the disease, HIV continues to multiply in the body but at very low levels. People with chronic HIV infection may not have any HIV-related symptoms. AIDS is the final stage of HIV infection. Because HIV has destroyed the immune system, the body can’t fight off opportunistic infections and cancer. Opportunistic infections can rarely occur during the transient CD4 lymphopenia of early HIV infection . Oral and esophageal candidiasis are the most common opportunistic infections in these patients . Other opportunistic infections that have been reported during acute HIV infection include CMV infection (proctitis, colitis, and hepatitis), Pneumocystis jiroveci pneumonia and prolonged, severe cryptosporidiosis (Figure 1) [17-19].
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