Study Compares HIV Saliva Self-Test To Blood Test

A saliva test used to diagnose the human immunodeficiency virus (HIV), is comparable in accuracy to the traditional blood test, according to a new study led by the Research Institute of the McGill University Health Centre (RI-MUHC) and McGill University. The meta-analysis, which compared studies worldwide, showed that the saliva HIV test, OraQuick HIV1/2, had the same accuracy as the blood test for high-risk populations. The test sensitivity was slightly reduced for low risk populations. The study, published in this week's issue of The Lancet Infectious Diseases, has major implications for countries that wish to adopt self-testing strategies for HIV.

"Testing is the cornerstone of prevention, treatment and care strategies," says the study's lead author, Dr. Nitika Pant Pai, a medical scientist at the RI-MUHC and assistant professor of Medicine at McGill University. "Although previous studies have shown that the oral fluid-based OraQuick HIV1/2 test has great promise, ours is the first to evaluate its potential at a global level."

Dr. Pant Pai and her colleagues analyzed and synthesized real-life field research data from five worldwide databases. Their findings showed that the saliva test is 99 percent accurate for HIV in high risk populations, and about 97 percent in low risk populations.

The oral HIV test has become one of the most popular tests because of its acceptability and ease of use. It is non-invasive, pain-free, and convenient and produces results in 20 minutes. "Getting people to show up for HIV testing at public clinics has been difficult because of visibility, stigma, lack of privacy and discrimination. A confidential testing option such as self-testing could bring an end to the stigmatization associated with HIV testing," says Dr. Pant Pai, whose work is supported by a Grand Challenges Canada's Rising Star in Global Health Award. "There is a huge global momentum for alternate HIV self-testing strategies that can inform people know of their status."

High risk populations fuel the expansion of HIV epidemics but they face widespread discrimination, violence and social marginalization from healthcare services. UNAIDS estimates that globally, 90% of men who have sex with men lack access to the most basic sexual health services. "Oral HIV tests can be a powerful tool for high risk populations, but self-testing must be accompanied by linkage to care to achieve good health outcomes," says the study's co-author Dr. Rosanna Peeling, Professor and Chair of Diagnostics Research at the London School of Hygiene & Tropical Medicine.

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References:
About this study: The study, Head-to-head comparison of accuracy of a rapid point-of-care HIV test with oral versus whole-blood specimens: a systematic review and meta-analysis, was coauthored by Nitika Pant Pai (RI-MUHC/McGill), Bhairavi Balram (McGill), Sushmita Shivkumar (McGill), Jorge M Cajas (Queen's University, Kingston), Christiane Claessens (Institut National de santé publique du Québec), Gilles Lambert (Direction de santé publique de l'agence de la santé et des services sociaux de Montréal, INSPQ), Rosanna W Peeling (London School of Hygiene and Tropical Medicine, UK), and Lawrence Joseph (RI-MUHC/McGill).
Partners in research: This work has been made possible by a Knowledge Syntheses Grant from Canadian Institutes of Health Research (CIHR).
McGill University Health Centre

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27 Jan. 2012.

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http://www.medicalnewstoday.com/releases/240748.php.

usdata

US underestimated country's HIV epidemic

WASHINGTON (AFP) — US health authorities acknowledged that they had substantially underestimated the number of new HIV infections in the country, in a study showing that the epidemic is worse than previously thought.

About 56,300 people were infected with the virus that causes AIDS in 2006, a figure 40 percent higher than the previous estimate of 40,000 new infections a year, the Centers for Disease Control and Prevention (CDC) said Saturday.

"This new picture reveals that the HIV epidemic is -- and has been -- worse than previously known and underscores the challenges in confronting this disease," Kevin Fenton, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

The revised assessment came on the eve of a six-day international AIDS conference in Mexico City, which is expected to be attended by some 22,000 scientists, policymakers and grassroots workers.

The CDC said new technology allowed it to establish a more precise estimate of the epidemic.(I would like to have a look)

"These data, which are based on new laboratory technology developed by CDC, provide the clearest picture to date of the US HIV epidemic, and unfortunately we are far from winning the battle against this preventable disease," said CDC Director Julie Gerberding.

"We as a nation have to come together to focus our efforts on expanding the prevention programs we know are effective," she said.

The study found that the annual number of new infections was never as low as 40,000. While new infections increased in the last 1990s, they have been roughly stable since then.

"While the level of HIV incidence is alarming, stability in recent years suggests that prevention efforts are having an impact," said Richard Wolitski, acting director of the CDC's Division of HIV/AIDS Prevention.

The study also found that gay and bisexual men as well as and African American men and women are the groups most affected by HIV.

The new estimate found that 53 percent of new infections occurred in gay and bisexual men, while heterosexuals accounted for 31 percent of them and injection drug users for 12 percent.

African Americans, who make up 13 percent of the US population, accounted for 45 percent of the new infections in 2006. The infection rate among blacks was seven times higher than among whites -- 83.7 out of 100,000 people compared to 11.5 out of 100,000.

The study found some encouraging signs of progress as new infections have dropped among both injecting drug users and heterosexuals.

The CDC said the new estimate will be published in a special HIV/AIDS issue of the Journal of the American Medical Association that was to be released in Mexico City on Sunday. The agency released them Saturday because news organizations broke the embargo.

Anti-AIDS groups said the revised estimate showed that the HIV infection rate was not dropping and may be increasing significantly, and that it highlighted the need for a comprehensive national strategy to combat AIDS.

"HIV/AIDS continues to be a public health emergency that has not received adequate nor appropriate attention as a nationwide priority," said Julie Davids, Executive Director of the Community HIV/AIDS Mobilization Project (CHAMP).

"To make measurable progress against HIV, we need to know whether infection rates are going up, which groups are becoming infected, and which prevention activities reduce new infections," said Mark Cloutier, chief executive officer of the San Francisco AIDS Foundation.

"We need a comprehensive National AIDS Strategy with measurable outcome targets, a timeline for action, increased funding and a particular focus on those most at risk, including racial and ethnic minorities."

Joseph Interrante, chairman of the AIDS Action Council's board of directors said the revised figures represented "an unacceptable level of new HIV infections for a preventable disease."

"The revised estimate underlines the need for a national AIDS strategy with measurable outcomes, reliance on evidence-based programs, and sufficient funding," Interrante said in a statement.

Source: AFP, 3 August 2008.

new_approach

More Americans Infected with HIV Each Year Than Previously Thought

CDC estimates of the number of Americans infected with HIV annually are likely to increase from the current figure of 40,000, according to news reports.The CDC has been working to develop a more accurate estimate, using technology that distinguishes new from long-standing infections. According to the New York Times, several newspapers have reported that the new estimate will approximate 60,000 infected during the most recent 12-month period.In a statement released Sunday, a CDC AIDS official said the new estimate has been "submitted for further analysis and rigorous scientific review" and is not yet final, Reuters reports.

Link(s):New York Times story (One-time registration required) http://www.nytimes.com/2007/12/02/health/02aids.html?_r=1&ref=health&oref=sloginReuters story (Free) http://www.reuters.com/article/newsOne/idUSN0232907520071202