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Table of Contents   
LETTER TO THE EDITOR  
Year : 2017  |  Volume : 10  |  Issue : 6  |  Page : 1837-1838
World Health Organization prequalifies tests to respond to the challenge of early diagnosis of HIV in infants


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Chennai, Tamil Nadu, India

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Date of Web Publication11-Jan-2018
 

How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. World Health Organization prequalifies tests to respond to the challenge of early diagnosis of HIV in infants. Ann Trop Med Public Health 2017;10:1837-8

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. World Health Organization prequalifies tests to respond to the challenge of early diagnosis of HIV in infants. Ann Trop Med Public Health [serial online] 2017 [cited 2018 May 22];10:1837-8. Available from: http://www.atmph.org/text.asp?2017/10/6/1837/196676


Dear Sir,

Globally, HIV has been recognized as an important health concern, with 2 million and 1.2 million being the incidence and the attributable deaths, respectively, for the year 2014.[1] However, acquisition of the infection in the perinatal period has been associated with extremely high levels of morbidity and mortality during infancy.[1] The high fatality and morbidity is predominantly due to the limited access to a diagnostic test in the first year of life.[2] In fact, in the year 2015, out of more than 1.2 million infants born to an HIV-positive mother, only 50% had access to an infant diagnostic test.[1] In other words, lack of access to a diagnostic test is an indicator of the alarming fact that only half of all the infected children actually receive the desired treatment.[2]

The global consensus with regard to establishing a diagnosis of HIV infection among infants is to employ those tests that ascertain the presence of the causative organism in the blood, instead of estimating evidences of antibodies or antigens.[3]

There is no doubt that the establishment of an early infant diagnosis coupled with prompt initiation of treatment significantly reduces the risk of complications and enhances the survival chances; nevertheless, access to the such diagnostic tools is extremely limited in resource-poor settings.[1],[3]

The currently available evidence suggests that in most of the settings, the infection in infants is diagnosed through a polymerase chain reaction (PCR) testing, which in itself requires expensive equipments and highly skilled personnel.[1] However, in developing nations, most of these tests are available in centralized urban locations, and hence a major proportion of poor, rural, and vulnerable populations are completely devoid of the existing services.[2],[3],[4] In addition, the total turnaround time for such centralized things right from sampling to the initiation of treatment is very much high and thus there is a significant attrition of infected infants at each of the essential steps.[3],[4] Moreover, due to the advances in the field of prevention of mother-to-child transmission of infection, more effective treatment regimen, and expansion of services, it is extremely essential to diagnose the infection at the earliest in infancy.[3],[4]

Point-of-care (POC) technologies have been identified as the possible answer to the existing challenges in achieving effective delivery of HIV prevention and treatment services.[1],[3] Moving ahead, two products, namely Alere q HIV-1/2 Detect and Xpert HIV-1 Qual Assay, have been prequalified by the World Health Organization (WHO) to establish the diagnosis among infants within an hour, and hence overcome the risk of attrition or delay by addressing the concerns of logistics, training of staff, transport, testing, return of the results, and recall of the patients.[2]

Both of these products are simpler, faster, automatic, can be used at or near the point of care or rural/remote settings (Xpert needs a continuous power supply, while Alere runs on battery for 8 h), and even cater to the diagnostic needs of a number of infants.[2],[3],[4] These products have been evaluated in high-burden settings to lay down the recommendations for their application and on receiving prequalification by the WHO, the test attributes (viz., quality of results, safety, performance, etc.) can be assured.[2],[3],[4] In addition, these products can now be procured by international agencies and then distributed to low-income nations in responding to the challenge of early diagnosis of infection in infants.[2]

To conclude, the prequalification of the tests is a significant milestone in extending care and support to HIV-infected young children. At the same time, these tests remain quite an effective option to address the shortcomings in the existing diagnostic tool and hence minimize the attrition rate and improve the rates of diagnosis-cum-treatment initiation.

Acknowledgement

SRS contributed in the conception or design of the work, drafting of the work, approval of the final version of the manuscript, and agreed for all aspects of the work.

PSS contributed in the literature review, revision of the manuscript for important intellectual content, approval of the final version of the manuscript, and agreed for all aspects of the work.

JR contributed in revising the draft, approval of the final version of the manuscript, and agreed for all aspects of the work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
World Health Organization. HIV/AIDS-Fact sheet No. 360; 2015. Available from: http://who.int/mediacentre/factsheets/fs360/en/. [Last Accessed on 2016 June 22].   Back to cited text no. 1
    
2.
World Health Organization. Two cutting-edge technologies for HIV detection in infants receive WHO prequalification; 2016. Available from: http://who.int/diagnostics_laboratory/cutting-edge-hiv-prequal/en/. [Last Accessed on 2016 June 22].  Back to cited text no. 2
    
3.
Michaeli M, Wax M, Gozlan Y, Rakovsky A, Mendelson E, Mor O. Evaluation of Xpert HIV-1 Qual assay for resolution of HIV-1 infection in samples with negative or indeterminate Geenius HIV-1/2 results. J Clin Virol 2016;76:1-3.  Back to cited text no. 3
[PUBMED]    
4.
Hsiao NY, Dunning L, Kroon M, Myer L. Laboratory evaluation of the Alere q point-of-care system for early infant HIV diagnosis. PLoS ONE 2016;11:e0152672.  Back to cited text no. 4
[PUBMED]    

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Correspondence Address:
Saurabh R Shrivastava
3rd Floor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai Village, Thiruporur, Guduvancherry Main Road, Sembakkam Post, Kancheepuram, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.196676

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