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Human Immunodeficiency Virus 1 (HIV-1) with Western Blot Confirmation
Human immunodeficiency virus (HIV), the etiologic agent of the acquired immunodeficiency syndrome (AIDS) is a cytopathic retrovirus. This test uses a viral lysate as the antigen source and detects antibodies by specific immune binding and subsequent color development (enzyme immunoassay (EIA) technology). Sensitivity and specificity of this assay are 100% and 99.7% respectively. Sera which are repeatedly reactive in two out of three tests are subject to confirmatory testing by the Western blot method. Some individuals may be initially reactive by the preliminary test and negative or indeterminate by Western blot. This may be caused by other viral antibodies or autoantibodies which cross reacts with the viral antigens although this is extremely rare.
Human Immunodeficiency Virus 2 (HIV-2) with Western Blot Confirmation
In 1986, a second type of HIV, called HIV-2, was isolated from AIDS patients in West Africa. Studies of the natural history of HIV-2 are limited, but comparisons with HIV-1 show some similarities while suggesting differences. Both HIV-1 and HIV-2 have the same modes of transmission and are associated with similar opportunistic infections and AIDS. Patients infected with HIV-2 may have a negative or indeterminate result by standard HIV-1 serology. The development of antibodies is similar in HIV-1 and HIV-2. Antibodies generally become detectable within 3 months of infection. Testing for combined HIV-1 and HIV-2 is available.
Hepatitis B Surface Antigen Hepatitis B virus (HBV) is a DNA virus with a protein coat, the surface antigen (HBsAg) and a nucleic acid core, the core antigen (HBcAg). There are eight different serotypes. Early in infection, HBsAg, HBV DNA, and DNA polymerase can all be detected in serum. HBsAg can be detected one to seven weeks before liver enzyme elevation or the appearance of clinical symptoms. Three weeks after the onset of acute hepatitis about 50% of the patients will still be positive for HBsAg, while at 17 weeks only 10% are positive. The best available markers for infectivity are HBsAg and HBeAg. The presence of anti-HBs is frequently associated with non-infectivity. The chronic carrier state is indicated by the persistence of HBsAg and/or HBeAg over long periods (six months to years) without seroconversion to the corresponding antibodies. Such a condition has the potential to lead to serious liver damage, but may be an isolated asymptomatic serologic phenomenon.
Hepatitis C Virus (HCV) Antibody
Following the development of sensitive and specific testing for hepatitis B, 90% of post-transfusion hepatitis is now hepatitis C. A gene product (c100) of hepatitis C virus (HCV) was isolated and an assay for anti-HCV developed. The assay detects antibody to a presumptive togavirus or flavivirus which may be an etiologic agent of non-A, non-B hepatitis (which may not be a unitary disease entity). For blood donors, hepatitis C serology correlates with surrogate tests for non-A, non-B hepatitis (ALT and anti-HBc). Since hepatitis C serology identifies a broader group of infected individuals than surrogate testing, it reduces risk of HCV during transfusion. Studies in hemophiliacs indicate that antibody to HCV is a reliable marker of HCV.
