HIV laboratory diagnosis and critical assessment of predictors of clinical outcome
Ríos-Olivares, E.
Boletin de la Asociacion Medica de Puerto Rico 91(1-6): 15-21
1999
ISSN/ISBN: 0004-4849 Document Number: 703016
Although there are several clinical laboratory criteria currently being used to assess the clinical status of patients infected with the Human Immunodeficiency Virus (HIV), there still remain great difficulties in establishing the correct diagnosis. This is especially true during the primary infection. On the other hand, in an unprecedented effort, investigators are directing their research activities towards defining reliable predictors of clinical outcome. In this manuscript two case reports are presented to illustrate the complexity of the problem. The usefulness of available serologic tests (i.e., ELISA-ab, Western blot, p24) and nucleic acid-based assays (i.e., PCR, bDNA, NASBA) are discussed. In addition, the most adequate combinations of several immunological markers (i.e., CD4+, CD8+, CD45RA+, CD45R0+, IgG, IgA, cytokines, chemokines) as well as syncytium-inducing capacity, are proposed as predictors of disease progression. Potential innovative nucleic acid - based technology to expedite accurate results and lower costs as well as the present status of HIV-1 drug resistant testing, is addressed. It is suggested that in spite of the battery of tests available, a high degree of inquisitiveness by the physician managing potential HIV primary infection, is needed to correctly diagnose this condition.
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