Ménard Didier, Mavolomadé Elisa Euridice, Mandeng Marie-Joëlle, Talarmin Antoine
Institut Pasteur de Bangui, BP923, Bangui, Central African Republic.
J Virol Methods. 2003 Aug;111(2):129-34. doi: 10.1016/s0166-0934(03)00169-1.
Voluntary testing and counselling are accepted widely for the prevention of human immunodeficiency virus (HIV) infection. Therefore, simple, accurate and affordable tests are required. The diagnosis strategy used in developed countries, based on an immunoblot confirmatory test, cannot be used on a large scale in developing countries because of its cost. Therefore, alternative strategies must be developed. In this study, we tested according UNAIDS and World Health Organisation recommendations for HIV testing strategies, a strategy based on two consecutive tests, using the mixed automatic enzyme immunoassays test Vidas HIV DUO as a screening test and Determine Abbott rapid immunochromatographic test as a confirmatory test. In first step, reference serum samples (113 HIV-positive and 167 HIV-negative) were used to evaluate the performance of both tests. In a second step, 876 serum samples from patients were used to compare the 'simultaneous' testing strategy currently used in Central African Republic (CAR) to the 'consecutive' testing strategy. The sensitivity and negative predictive value of both tests were 100%. The specificity and positive predictive value of Determine Abbott (>99%) were higher than those of Vidas HIV DUO (90.4 and 87.6%, respectively). In all cases in which the two tests gave discrepant results, the patient was considered HIV-negative after a second test carried out 2-4 weeks later since the optical density value of the Vidas HIV DUO of the second sample was not higher than that of the first sample. This new consecutive testing strategy appears to be reliable, simple and rapid, allowing counselling and results to be given on the same day, which we believe is important for improving post-test counselling. Furthermore, the consecutive testing strategy reduces the cost of testing, which is very important in developing countries.
自愿检测和咨询已被广泛用于预防人类免疫缺陷病毒（HIV）感染。因此，需要简单、准确且经济实惠的检测方法。发达国家基于免疫印迹确证试验的诊断策略，因其成本高昂而无法在发展中国家大规模使用。所以，必须制定替代策略。在本研究中，我们按照联合国艾滋病规划署（UNAIDS）和世界卫生组织（WHO）关于HIV检测策略的建议进行检测，即采用一种基于连续两次检测的策略，使用混合自动酶免疫分析检测Vidas HIV DUO作为筛查试验，以及Determine Abbott快速免疫层析试验作为确证试验。第一步，使用参考血清样本（113份HIV阳性和167份HIV阴性）来评估两种检测方法的性能。第二步，使用来自患者的876份血清样本，将中非共和国（CAR）目前使用的“同步”检测策略与“连续”检测策略进行比较。两种检测方法的灵敏度和阴性预测值均为100%。Determine Abbott的特异性和阳性预测值（>99%）高于Vidas HIV DUO的特异性和阳性预测值（分别为90.4%和87.6%）。在两种检测结果出现差异的所有情况下，由于第二次样本的Vidas HIV DUO光密度值不高于第一次样本，在2 - 4周后进行第二次检测后，该患者被判定为HIV阴性。这种新的连续检测策略似乎可靠、简单且快速，能够在同一天提供咨询和检测结果，我们认为这对于改善检测后咨询非常重要。此外，连续检测策略降低了检测成本，这在发展中国家非常重要。
