Diagnostic tests in HIV management: a review of clinical and laboratory strategies to monitor HIV-infected individuals in developing countries

Abstract

We conducted a systematic review on the performance of diagnostic tests for clinical and laboratory monitoring of HIVinfected adults in developing countries. Diagnostic test information collected from computerized databases, bibliographies and the Internet were categorized as clinical (non-laboratory patient information), immunologic (information from immunologic laboratory tests), or virologic (information from virologic laboratory tests). Of the 51 studies selected for the review 28 assessed immunologic tests, 12 virologic tests and seven clinical and immunologic tests. Methods of performance evaluation were primarily sensitivity and specificity for the clinical category and correlation coefficients for immunologic and virologic categories. In the clinical category, the majority of test performance measures was reported as >70% sensitive and >65% specific. In the immunologic category, correlation coefficients ranged from r = 0.54 to r = 0.99 for different CD4 count enumeration techniques, while correlation for CD4 and total lymphocyte counts was between r = 0.23 and r = 0.74. In the virologic category, correlation coefficients for different human immunodeficiency virus (HIV) ribonucleic acid (RNA) quantification techniques ranged from r = 0.54 to r = 0.90. Future research requires consensus on designing studies, and collecting and reporting data useful for decision-makers. We recommend classifying information into clinically relevant categories, using a consistent definition of disease across studies and providing measures of both association and accuracy.

Development and Validation of Decision Rules to Guide Frequency of Monitoring CD4 Cell Count in HIV-1 Infection before Starting Antiretroviral Therapy

“…Overuse of costly determinations is undesirable. However, timely introduction of antiretroviral therapy is essential in preventing AIDS and death, and underuse of monitoring in developing countries has detrimental consequences [9] , [10] . Two recent simulation studies concluded that improved HIV detection and pre-treatment CD4 monitoring in resource-poor settings could save several life-years per person taking antiretroviral treatment and could be cost-effective by preventing opportunistic infections [11] , [12] , [13] .…”

Cost‐Effectiveness of Laboratory Monitoring in Sub‐Saharan Africa: A Review of the Current Literature

“…While these technologies are the standard of care in well-resourced countries, the benefits of these tools must be weighed against their costs in resource-limited countries [1-4]. Some argue that complicated monitoring technologies impede the overall goal – to deliver antiretroviral therapy to as many patients as possible.…”

Biosensors as rapid diagnostic tests for tropical diseases

“…172 Comprehensive studies including test methods, statistical methods, test results and estimates and participant data are crucial information for program management and policy making for appropriate disease monitoring and management. 173 By using a specific RNA aptamer, a piezoelectric biosensor for the protein trans-activator of transcription (Tat) of HIV-1 was built, through binding between the biotinylated aptamer and gold surface-deposited streptavidin. 56 This model system exhibited comparable performance to that of the homologous anti-Tat immunosensor.…”