HIV Insight: Acute Infections, Cost per Infection and Turnaround Time in Three United States Hospital Laboratories Using Fourth-Generation Antigen-Antibody Human Immunodeficiency Virus Immunoassays

Background.

To improve clinical and public health outcomes through early human immunodeficiency virus (HIV) detection, fourth-generation antigen/antibody immunoassay (4IA) and supplemental testing results must be returned rapidly.

Methods.

We examined HIV testing data at Harborview Medical Center (HMC), Massachusetts General Hospital (MGH), and the Medical University of South Carolina (MUSC), which used 4IA and supplemental antibody and nucleic acid tests (NATs). At MGH and MUSC, HIV-1 Western blot (WB) and HIV-2 testing were conducted at a reference laboratory. We compared time from specimen collection to laboratory result for established (positive WB) and acute infections (reactive 4IA, negative/indeterminate WB, detectable NAT), and we calculated testing cost per positive-test result.

Results.

From 3731 (MUSC) to 19 774 (MGH) tests were conducted; 0.01% (MGH) to 0.05% (HMC) were acute infections. Each laboratory had reactive 4IA, WB-negative, or indeterminate specimens without NAT (ie, potential acute infections). Time to result was 1.5 (HMC) to 5.2 days (MGH) for acute and 1.0 (HMC) to 5.2 days (MGH) for established infections. Costs were $1054 (MGH) to $1521 (MUSC).

Conclusions.

Conducting supplemental testing in-house lowered turnaround times, which may be further reduced with rapid HIV-1/HIV-2 differentiation tests. Hospitals may benefit from quantitative NATs not requiring physician orders, so all potential acute infections receive NAT.

Below: HIV testing algorithm used at Massachusetts General Hospital and the Medical University of South Carolina

Below: HIV testing algorithm used by Harborview Medical Center

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By: Wesolowski LG1, Nasrullah M1, Coombs RW2, Rosenberg E3, Ethridge SF1, Hutchinson AB1, Dragavon J4, Rychert J5, Nolte FS6, Madory JE6, Werner BG7.

1Division of HIV/AIDS Prevention , National Center for HIV, Hepatitis, STD & TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia.
2Departments ofLaboratory Medicine; Medicine, Harborview Medical Center, Seattle, Washington.
3Departments ofMedicine; Pathology, Massachusetts General Hospital, Boston.
4Departments of Laboratory Medicine.
5Pathology , Massachusetts General Hospital , Boston.
6Department of Pathology and Laboratory Medicine , Medical University of South Carolina , Charleston.
7Bureau of Infectious Disease, Massachusetts Department of Public Health, Boston.
Open Forum Infect Dis. 2015 Dec 9;3(1):ofv188. doi: 10.1093/ofid/ofv188. eCollection 2016.