HIV ANTIBODY
TESTING WITH SALIVA
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HIV ANTIBODY
TESTING WITH SALIVA |
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© 1999 Last Updated 02 Nov 2002 |
DATED THROUGH 1996 The least expensive way to determine infection by the human immunodeficiency virus (HIV) is to test for the presence of HIV antibodies. Diagnostic testing is done in two stages, a screening test and a confirmatory test. The screening test is done on the initial submitted blood specimen, usually with an enzyme-linked immunoadsorbent assay (ELISA). If non-reactive for HIV antibodies, the screening test is termed negative and no further testing is done. If reactive or inconclusive for HIV-antibodies, the screening test is repeated but this time with a confirmatory test such as the Western blot, immunoflourescent assay (IFA), or two different ELISA. If the confirmatory test is positive, the person likely has been infected with the HIV virus. Because of the serious nature of this diagnosis and the possibilities of test or laboratory error, persons who are diagnosed HIV positive are typically asked to return at a later time for another independent diagnostic test. In the United States, all persons who obtain the HIV test are expected to be counseled, both before the blood specimen is collected and after the results are known. The cost of such testing is high, usually ranging from about $50-75 for a negative test sequence to $150-175 for a positive test sequence. At federally-funded HIV testing centers in the United States, more than 95 percent of persons receiving blood tests are found to be negative. Thus the majority of funds spent by the US government for HIV testing goes to counseling and testing of uninfected persons. An alternative to blood testing is to use saliva which also contains HIV antibodies, but at lower concentrations. Many investigators have studied and evaluated saliva tests and found them to be almost as valid as blood tests. Validity is measured by sensitivity, the percentage that measures positive with the test among those who truly have HIV antibodies, and specificity, the percentage that measures negative with the test among those who truly do not have HIV antibodies. Saliva tests have been recommended and used for population surveys, surveillance programs, and personal screening. The test would be especially useful for screening since the saliva specimen could be collected in the privacy of the home, shipped to a laboratory and the results heard over the telephone. If the screening test is positive, the person would be referred to a health care provider for counseling and diagnostic testing with blood. With such a system, the percentage of persons at testing centers who are HIV negative would be greatly decreased, allowing more time and effort to be spent on those truly infected with the deadly virus. Such personal screening programs, however, are not yet legal in the United States because saliva tests for home use have not been licensed by the Food and Drug Administration (FDA). A summary of all publications on saliva tests that have appeared to 1996 is shown below in Table 1.
REFERENCES 1. Parry JV, Perry KR, Mortimer PP. Sensitive assays for viral antibodies in saliva: an alternative to tests on serum. Lancet 1987; 335:72-75. 2. Johnson AM, Parry JV, Best SJ, Smith AMA, Mortimer PP. HIV surveillance by testing saliva. Aids 1988; 2(5):369-371. 3. Holmstrom P, Syrjanen S, Laine P, Valle SL, Suni J. HIV antibodies in whole saliva detected by ELISA and western blot assays. Journal of Medical Virology 1990; 30(4):245-248. 4. O'Shea S, Cordery M, Barrett WY, Richman DD, Bradbeer C, Banatvala JE. HIV excretion patterns and specific antibody responses in body fluids. Journal of Medical Virology 1993; 31(4):291-296. 5. Archibald DW, Hebert CA. Salivary detection of HIV-1 antibodies using recombinant HIV-1 peptides. Viral Immunology 1991; 4(1):17-22. 6. Behets F, Edidi B, Quinn TC, Atikala L, Bishagara K, Nzila N, et al. Detection of salivary HIV-1-specific IgG antibodies in high-risk populations in Zaire. Journal of Acquired Immune Deficiency Syndromes 1991; 4(2):183-187. 7. Major CJ, Read SE, Coates RA, Francis A, McLaughlin BJ, Millson M, et al. Comparison of saliva and blood for human immunodeficiency virus prevalence testing. Journal of Infectious Diseases 1991; 163(4):699-702. 8. Crofts N, Nicholson S, Coghlan P, Gust ID. Testing of saliva for antibodies to HIV-1. Aids 1991; 5(5):561-563. 9. Coates R, Millson M, Myers T, Rankin J, McLaughlin B, Major C, et al. The benefits of HIV antibody testing of saliva in field research. Canadian Journal of Public Health 1991; 82(6):397-398. 10. Klokke AH, Ocheng D, Kalluvya SE, Nicoll AG, Laukamm-Josten U, Parry JV, et al. Field evaluation of immunoglobulin G antibody capture tests for HIV-1 and HIV-2 antibodies in African serum, saliva and urine [letter]. Aids 1991; 5(11):1391-1392. 11. van den Akker R, van den Hoek JA, van den Akker WM, Kooy H, Vijge E, Roosendaal G, et al. Detection of HIV antibodies in saliva as a tool for epidemiological studies. Aids 1992; 6(9):953-957. 12. Gershy-Damet GM, Koffi K, Abouya L, Sasson-Morokro M, Brattegaard K, Parry JV, et al. Salivary and urinary diagnosis of human immunodeficiency viruses 1 and 2 infection in Cote d'Ivoire, using two assays. Transactions of the Royal Society of Tropical Medicine and Hygiene 1992; 86(6):670-671. 13. Soto-Ramirez LE, Hernandez-Gomez L, Sifuentes-Osornio J, Barriga-Angulo G, Duarte de Lima D, Lopez-Portillo M, et al. Detection of specific antibodies in gingival crevicular transudate by enzyme-linked immunosorbent assay for diagnosis of human immunodeficiency virus type 1 infection. Journal of Clinical Microbiology 1992; 30:2780-2783. 14. Frerichs RR, Htoon MT, Eskes N, Lwin S. Comparison of saliva and serum for HIV surveillance in developing countries. Lancet 1992; 340:1496-1499. 15. Thongcharoen P, Wasi C, Louisirirotchanakul S, Parry J, Connell J, Mortimer P. Immunoglobulin G antibody capture enzyme-linked immunosorbent assay: a versatile assay for detection of anti-human immunodeficiency virus type 1and 2 antibodies in body fluids. Journal of Clinical Microbiology 1992; 30(12):3288-3289. 16. Covell R, Follett E, Coote I, Bloor M, Finlay A, Frischer M, et al. HIV testing among injecting drug users in Glasgow. Journal of Infection 1993; 26(1):27-31. 17. Hunt AJ, Connell J, Christofinis G, Parry JV, Weatherburn P, Hickson FC, et al. The testing of saliva samples for HIV-1 antibodies: reliability in anon-clinic setting. Genitourinary Medicine 1993; 69(1):29-30. 18. Connell JA, Parry JV, Mortimer PP, Duncan J. Novel assay for the detection of Immunoglobulin G anti-human immunodeficiency virus in untreated saliva and urine. Journal of Medical Virology 1993; 41:159-164. 19. Chamnanput J, Phanuphak P. Comparison of eight commercial test kits for detecting anti-HIV antibodies in saliva specimens [letter]. Aids 1993; 7(7):1026 20. Holm-Hansen C, Constantine NT, Haukenes G. Detection of antibodies to HIV in homologous sets of plasma, urine and oral mucosal transudate samples using rapid assays in Tanzania. Clinical and Diagnostic Virology 1993; 1(3):207-214. 21. Urquia M, Rodriguez-Archilla A, Gonzalez-Moles MA, Ceballos A. Detection of anti-HIV antibodies in saliva. Journal of Oral Pathology and Medicine 1993; 22(4):153-156. 22. Frerichs RR, Eskes N, Htoon MT. Validity of three saliva assays for HIV-antibodies. Journal of Acquired Immune Deficiency Syndromes 1994; 7(5):522-524. 23. Chassany O, Bergmann JF, Mazeron MC, Cervoni J, Gregoire V, Sanson-Le-Pors MJ, et al. Testing of anti-HIV antibodies in saliva. Aids 1994; 8(5):713 24. Frerichs RR, Silarug N, Eskes N, Pagcharoenpol P, Rodklai A, Thangsupachai S, et al. Saliva-based HIV antibody testing in Thailand. Aids 1994; 8:885-894. 25. Lu XS, Delfraissy JF, Grangeot-Keros L, Rannou MT, Pillot J. Rapid and constant detection of HIV antibody response in saliva of HIV-infected patients; selective distribution of anti-HIV activity in the IgG isotype. Research in Virology 1994; 145:369-377. 26. King A, Marion SA, Cook D, Rekart M, Middleton PJ, O'Shaughnessy MV, et al. Accuracy of a saliva test for HIV antibody. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1995; 9:172-175. 27. Emmons WW, Paparello SF, Decker CF, Sheffield JM, Lowe-Bey FH. A modified ELISA and western blot accurately determine anti-human immunodeficiency virus type 1 antibodies in oral fluids obtained with a special collecting device. Journal of Infectious Diseases 1995; 171:1406-1410. 28. Luo N, Kasolo F, Ngwenya BK, du Pont HL, Zumla A. Use of saliva as an alternative to serum for HIV screening in Africa. South African Medical Journal 1995; 85:156-157. 29. Vall Mayans M, Casabona J, Rabella N, De Miniac D. Comparison of saliva and serum for HIV testing among populations with high risk behaviors. European J Clinical Microbiology and Infectious Diseases 1995; 14:710-713. 30. Martinez P, Ortiz de Lejarazu R, Eiros JM, Perlado E, Flores M, del Pozo MA, et al. Comparison of two assays for detection of HIV antibodies in saliva. European J Clinical Microbiology and Infectious Diseases 1995; 14:330-336. 31. Wongba C, Pagcharoenpol P, Eskes N, Frerichs RR, Silarug N. HIV saliva test for surveillance and surveys. Aids 1995; 9:1104-1105. 32. Ishikawa S, Hashida S, Hashinaka K, Hirota K, Saitoh A, Takamizawa A, et al. Diagnosis of HIV-1 infection with whole saliva by detection of antibody IgG to HIV-1 with ultrasensitive enzyme immunoassay using recombinant reverse transcriptase as antigen. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1995; 10:41-47. 33.Granade TC, Phillips SK, Parekh B, Pau CP, and George JR. Oral fluid as a specimen for detection and confirmation of antibodies to human immunodeficiency virus type 1. Clinical and Diagnostic Laboratory Immunology 1995; 2(4):395-399. 34. C.del Rio J, Guarner J, Izazola-Licea JA. The use of oral fluid to determine HIV-1 prevalence rates among men in Mexico City. Aids 1996; 10:233-235. |
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