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Rapid assay tests for HIV1 or VCTC which plays important role in Primary health care settings in West Bengal for surveillance, diagnosis & treatment of HIV1?
- Professor Pranab Kumar Bhattacharya, Bhattacharya RupakBsc(cal) Msc(jU), BhattacharyaRitwik, Purbapalli ,Sodepur, Kol-110,Chakraborty Srabani MD(cal)Path, Asst. prof,Ghosh Sougata MD(Micro) DCH, Bhattacharya PalashMD(path)PGT, Roychoudhury Suprio MD(Path) PGT,Roy Arnab IPGMER, KOl-20, India (13 June 2007)
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Re- discordant results from HIV rapid Testing
- Olubunmi momoh-Negedu (18 July 2007)
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Professor Pranab Kumar Bhattacharya, Professor pathology, Incharge unit, Cytogenetics, Blood Bank& VCTC , Exinchar Ronald Ross malaria cl Institute of Post graduateMedical Education& Research,244A AJC Bose Road, Kolkata-700020, W.B, Indi, Bhattacharya RupakBsc(cal) Msc(jU), BhattacharyaRitwik, Purbapalli ,Sodepur, Kol-110,Chakraborty Srabani MD(cal)Path, Asst. prof,Ghosh Sougata MD(Micro) DCH, Bhattacharya PalashMD(path)PGT, Roychoudhury Suprio MD(Path) PGT,Roy Arnab IPGMER, KOl-20, India
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In the state of West Bengal, India, total numbers of sero-positive for HIV1 (up to may 2006) detected 14,958 (sero-prevalence 0.019%) cases amongst population 8.2 cores (2001 census) and numbers of AIDS cases (May 2006) reported 5952 cases. 95% of HIV strain in West Bengal is subtype C amongst female sex workers (CSW) and 68% showed maximum homology to C3 Indian reference strain. Route of transmission is heterosexual (86.13%), blood and blood products (3.39%, mostly from private blood Banks of metropolis), infected needles (4.06%) and pre-natal & others (6.43%). Major route of transmission of HIV1 is heterosexual route and there is downhill (from 10% in 1990 to 3.39%) in transmission through blood and blood products for screening of donated blood in government blood banks for HIV1&2 as mandatory one. In government blood banks it is done by detection of antibodies by ELISA. A weakly positive sample is cross checked and if it becomes positive for a 2nd time it is then sent to apex center for Western Blot P24 antigen Test, which costs around RS 3000/= per test. Voluntary council & testing center (VCTC) is under govt. blood banks [funded by NACO] tests referred cases from STD or Prenatal screening & donated blood. In West Bengal there are 18 VCTC centers of which 8 centers are in Kolkata metropolis and rest 10 centers are distributed in districts which authors consider very insufficient for testing HIV burden in this state. IN VCTC centers there is scope for free HIV 1&2 antibody serological tests by ELISA. In west Bengal there are apex centers, one in Kolkata (Calcutta School of Tropical Medicine) where CD4 cell counting (costs Rs250-500/=) and P24 (western Blot) tests are selectively available. Another center is North Bengal Medical College, Siliguri. In metropolis there exists minimum facility for CD4 testing and even the settings have flow-cytometer in public sector, faces often shortage of reagent supply, equipment breakdown, interruption of refrigerator & electricity. Cost of CD4 is 1800-2000/= depending on private lab of Kolkata city. Viral load tests by PCR or bDNA is not done at government or NACO centers. Cost of mRNA by HIV1RNAQT(2) kit (Organon,USA) is around RS 4000/=. Disease wise AIDS cases show number of AIDS cases are highest in Kolkata (3014) followed by Medinapore (1332), S- 24 parganas (775), N-24 parganas (684), Darjeeling (499), Hoogly (548), Howrah (412) Burdwan (420). Other districts like Coach behar, Jalpaiguri, Malda, Dinazpur, Nadia, Bankura, Purulia ranges of AIDs cases varies between 100-350.(3) Diagnosis of HIV1 infection is based on detection of specific antibodies, antigen (P24) or both. Many commercial kits are available in the market. But the qualities of these kits are important factor for selection in regard to specificity & sensitivity. Serological tests for HIV1/HIV2 are used for screening as in VCTC and in donated bloods in blood banks. Twice ELISA +ve cases are put to confirmatory tests P24 antigen. P24 antigen test is costly and not cost effective for screening purpose in developing state/country. A major advance here is HIV1 rapid antibody tests. This assay is easy to perform in laboratory and results are obtained by 20 minutes (1). Rapid assay tests can be important tests for surveillance, screening and diagnosis and can be reliably done with plasma, serum, whole blood or saliva. Health care technicians can perform this test with or without expertise. The three important limitations are 1) detection of infection when antibodies had not developed or absent 2) in infants younger than 18 months who may bear maternal HIV antibody. In these situations direct virus detection by HIVRNAQT(2) even with dried blood spot sample remains option or by P24 detection in heat denatured serum(cost effective)3) Some times weak positive bands causes confusion which may be further confirmed by p24 antigen assay An important question strikes mind of authors that in West Bengal, when heterosexual transmission of HIV1 is most common route of transmission and detection of HIV1 is through VCTC centers mostly, does VCTC actually lower the rate of detection in West Bengal? HIV in West Bengal is spreading in Community & no more localized in Red light areas. Of course VCTC is accepted practice globally. Authors think that a sizable portion of hIV infected people do not attain VCTC, even when they are referred to VCTC, due to social stigmatization. Pre-counseling also did not dramatically become effective in reducing high risk sexual activity and extramarital sex. If the scenario is such, then what is role of VCTC?. Rather a routine testing of HIV1 by rapid assay test can increase number of early diagnosis. Low detection rate is dangerous as it implies larger duration of infection & increased risk of transmission. But lowering the threshold for HIV testing will lead to early diagnosis & treatment of infected individual which may prevent development of AIDS& transmission of infection. So as per authors, hIV testing should be widely accepted as patients with risk of cancer do not require a VCTC before a chest X-ray or a FNAC or a patient with Tuberculosis do not require a VCTC for a sputum AFB& chest X-ray to be done. In these cases rapid tests may stand an important tool in primary health care setting of West Bengal. References 1)Greenwald.J.L, Burstein.GR, Pincus.J,Branson BA “ A rapid review of rapid HIV antibody test” Curr. Infect.dis. Rep 8:125-131:2006 2)C. Horwood, S. Liebeschuetz, D. Balaauw, S Cassol, S Quazi “ Diagnosis of pediatric HIV infection in primary health care setting with a clinical alogorythm” Bull. WHO 81(12):858-66:2003 3)Health on march, West Bengal 2005-06, State Bureau of Health Intelligence, Directorate of Health Services, Government of West Bengal, India, DHS AIDS data, Swastha Bhavan, Salt Lake city, Kolkata-69 P 172-176 Published by Dr. S. Ghosal ,Director17 Authors 1) Professor Pranab Kr Bhattacharya MD(Path) Cal, FIC path
(Ind.),Professor, Dept. of pathology, In charge of Histopathology Unit, in
charge of Cytogenetics, Ex-In charge of 24 hours Ronald Ross Malaria
clinic, Technical Supervisor In charge of Blood Bank,
Institute of Post Graduate Medical Education& Research (IPGMER)
244A AJC Bose Road, K0lkata-700020, West Bengal , India
2) Mr. Rupak Bhattacharya BSc(cal), MSc(JU)
7/51 Purbapalli Po= Sodepur ,Dist.- 24 parganas(North),West Bengal ,Pin
700110, India
3) Mr. Ritwik Bhattacharya B.Com(cal)
7/51 Purbapalli, Po= Sodepur, Dist.- 24 parganas(North), West Bengal ,
Pin 700110, India
4) Dr. Srabani Chakraborty MD(cal) Path, Assistant Professor, Pathology,
Institute of Post Graduate Medical Education &Research, 244A AJC Bose
Road, kOlkata-700020, India
5) Dr. Arnab Roy. MBBS(Cal)
6)Dr. Palash Bhattacharya MBBS(Cal), MD(PGT) Pathology
7) Dr. Suprio Raychaudhury MBBS(Cal), MD(PGT) Pathology
Dept. Of Pathology
Institute of Post Graduate Medical Education& Research (IPGMER)
244A AJC Bose Road, K0lkata-700020, West Bengal , India
Competing interests: The first author is in charge of VCTC center of IPGMER kolkata-20 |
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Olubunmi momoh-Negedu, laboratory technical officer Family Health International, Abuja Nigeria, PMB 44, Garki, abuja, Nigeria.
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I have a little issue also on outcome of results especially using Determine as a test kit, My country uses the parallel testing algorithm; Determine and Stat Pak also but My experience is that whenever the Determine kit is close to the expiry date it gives this funny faint band which now shifts the test to use of a Tie breaker (Unigold double check etc) that gives a non reactive result as final. I did investigate this problem in some of our sites and found that close expiration of about 5 -6 months gives this discrepancy in results. I think the manufacturer may need to specify on this non cold chain kit especially for poor resource settings the issue of expiry date and storage and also reliability of results. Competing interests: None declared |
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