Strategies for laboratory HIV testing: an examination of alternative approaches not requiring Western blot

Advances inlaboratory tests forantibodies tohumanimmunodeficiency virus (HIV) havepermitted the development ofalternative HIVtesting strategies that donotrequire useoftheWestern blot approach. Threestrategies areproposed. Instrategy I,seraaretested forHIVantibody using anenzyme-linked immunosorbent assay(ELISA)/rapid/simple (ERS)test; instrategy II, serareactive inaninitial ERStest areretested using asecondERStest; strategy Ill involves retesting with athird ERStest all serareactive intwoprevious ERStests. Wheretheobjective isidentification ofasymptomatic HIV-infected individuals, strategy Ill isproposed whereHIVprevalences inthestudy population are 10%.Strategy IIisrecommended wherethediagnosis ofHIV-related disease requires HIVtesting. Forserosurveillance, strategy IIisrecommended iftheprevalence is 10%.Useofstrategy Iisrecommended fortransfusion andtransplantation safety, atanyprevalence. Lower-cost laboratory HIVtesting will permit suchtesting tobecome morewidely available.