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Chapter 2 : Human Immunodeficiency Virus

Authors: Yun F. (Wayne) Wang1, Molly E. Eaton2, Audrey N. Schuetz3, Steven R. Nesheim4
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Affiliations: 1: Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30303; 2: Department of Medicine, Emory University School of Medicine, Atlanta, GA 30308; 3: Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30303; 4: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30308
Content Type: Monograph
Publication Year: 2009

Category: Clinical Microbiology

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Abstract:

Since AIDS was first reported 26 years ago, more scientific effort at both the national and international levels has been focused on human immunodeficiency virus (HIV) than on any other virus in modern history. There is still no vaccine available for prevention of HIV infection, but multiple antiretroviral (ARV) drugs are available for combination therapy to control the infection. Many laboratory technologies, including conventional or rapid immunological and molecular methods, have been developed and used for diagnosis of HIV infection, surveillance, epidemiology, and monitoring of therapy. Tests for initial diagnosis of infection include enzyme immunoassay (EIA) or enzyme-linked immunosorbent assay (ELISA), Western blotting (WB) and other confirmatory assays, rapid immunoassay, quantitative viral RNA detection assays (commonly known as viral load [VL] assays), and qualitative proviral DNA assays. Tests for determining prognosis and for monitoring of ARV therapy include VL assays, genotyping, and phenotyping assays. The current HIV-1 VL assays offer reliable testing with excellent sensitivity and specificity. While genotypic testing is an indirect measure of drug susceptibility, it is the primary methodology for the analysis of HIV drug resistance. Currently, the report and interpretation are based on HIV-1 mutations that are known to be associated with drug resistance. In summary, there have been many achievements in diagnostic microbiology for patients who are immunocompromised because of HIV infection. Newer immunological and molecular technologies will continue to lead the way in laboratory diagnosis of infection caused by HIV.

Citation: (Wayne) Wang Y, Eaton M, Schuetz A, Nesheim S. 2009. Human Immunodeficiency Virus, p 47-68. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch2
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Human Immunodeficiency Virus
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Citation: (Wayne) Wang Y, Eaton M, Schuetz A, Nesheim S. 2009. Human Immunodeficiency Virus, p 47-68. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch2
/content/10.1128/9781555815455.ch02.ch02fig01
Figure 1.
Schematic of HIV infection. RNA*, HIV-1 RNA or proviral DNA in the newborn. (Modified with permission from references , and .)
10.1128/9781555815455/f0048-01_thmb.gif
10.1128/9781555815455/f0048-01.gif
Image of Figure 1.
Figure 1.

Schematic of HIV infection. RNA*, HIV-1 RNA or proviral DNA in the newborn. (Modified with permission from references , and .)

Citation: (Wayne) Wang Y, Eaton M, Schuetz A, Nesheim S. 2009. Human Immunodeficiency Virus, p 47-68. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch2
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Figure 2.
Algorithm for screening, confirmation, and rapid tests for diagnosing HIV infection. *, possibly repeat with second different rapid assay or even third different assay for rapid confirmation. **, if positive, confirmed HIV-1 infection; if negative, repeat serology in 1 to 3 months.
10.1128/9781555815455/f0051-01_thmb.gif
10.1128/9781555815455/f0051-01.gif
Image of Figure 2.
Figure 2.

Algorithm for screening, confirmation, and rapid tests for diagnosing HIV infection. *, possibly repeat with second different rapid assay or even third different assay for rapid confirmation. **, if positive, confirmed HIV-1 infection; if negative, repeat serology in 1 to 3 months.

Citation: (Wayne) Wang Y, Eaton M, Schuetz A, Nesheim S. 2009. Human Immunodeficiency Virus, p 47-68. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch2
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/content/10.1128/9781555815455.ch02.ch02fig03
Figure 3.
Algorithm for monitoring HIV-1 infection and ARV therapy. CD4 measurement is not listed here because it is not HIV specific.
10.1128/9781555815455/f0063-01_thmb.gif
10.1128/9781555815455/f0063-01.gif
Image of Figure 3.
Figure 3.

Algorithm for monitoring HIV-1 infection and ARV therapy. CD4 measurement is not listed here because it is not HIV specific.

Citation: (Wayne) Wang Y, Eaton M, Schuetz A, Nesheim S. 2009. Human Immunodeficiency Virus, p 47-68. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch2
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Tables

Human Immunodeficiency Virus
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Citation: (Wayne) Wang Y, Eaton M, Schuetz A, Nesheim S. 2009. Human Immunodeficiency Virus, p 47-68. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch2
/content/10.1128/9781555815455.ch02.ch02tab01
Table 1.
Global epidemiology of HIV variants
Generic image for table
Table 1.

Global epidemiology of HIV variants

Citation: (Wayne) Wang Y, Eaton M, Schuetz A, Nesheim S. 2009. Human Immunodeficiency Virus, p 47-68. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch2
/content/10.1128/9781555815455.ch02.ch02tab02
Table 2.
Methods of screening and confirmation, including rapid methods
Generic image for table
Table 2.

Methods of screening and confirmation, including rapid methods

Citation: (Wayne) Wang Y, Eaton M, Schuetz A, Nesheim S. 2009. Human Immunodeficiency Virus, p 47-68. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch2
/content/10.1128/9781555815455.ch02.ch02tab03
Table 3.
NAAT methods for HIV-1
Generic image for table
Table 3.

NAAT methods for HIV-1

Citation: (Wayne) Wang Y, Eaton M, Schuetz A, Nesheim S. 2009. Human Immunodeficiency Virus, p 47-68. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch2
/content/10.1128/9781555815455.ch02.ch02tab04
Table 4.
The FDA-approved ARV drugs for HIV
Generic image for table
Table 4.

The FDA-approved ARV drugs for HIV

Citation: (Wayne) Wang Y, Eaton M, Schuetz A, Nesheim S. 2009. Human Immunodeficiency Virus, p 47-68. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch2
/content/10.1128/9781555815455.ch02.ch02tab05
Table 5.
Genotyping and phenotyping methods for HIV-1
Generic image for table
Table 5.

Genotyping and phenotyping methods for HIV-1

Citation: (Wayne) Wang Y, Eaton M, Schuetz A, Nesheim S. 2009. Human Immunodeficiency Virus, p 47-68. In Hayden R, Carroll K, Tang Y, Wolk D (ed), Diagnostic Microbiology of the Immunocompromised Host. ASM Press, Washington, DC. doi: 10.1128/9781555815455.ch2

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