کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
5667976 1592330 2017 5 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
HIV misdiagnosis: A root cause analysis leading to improvements in HIV diagnosis and patient care
موضوعات مرتبط
علوم زیستی و بیوفناوری ایمنی شناسی و میکروب شناسی میکروبیولوژی و بیوتکنولوژی کاربردی
پیش نمایش صفحه اول مقاله
HIV misdiagnosis: A root cause analysis leading to improvements in HIV diagnosis and patient care
چکیده انگلیسی


- Despite improvements in HIV testing and diagnostic algorithms there remains a small possibility of false positive result.
- The diagnosis of “elite controller” may mask a misdiagnosis and requires detailed confirmatory testing.
- Heterophilic antibodies have been implicated as a factor leading to false positive reactive screening results.
- Communication between clinic and laboratory is crucial for unusual results.

BackgroundStandard diagnostic testing for HIV infection has traditionally relied on a high sensitivity HIV antibody screening test using an enzyme-linked immunosorbent assay (ELISA) followed by a high specificity antibody confirmatory test such as a Western Blot. Recently several of the screening assays have been enhanced with an ability to identify p24 antigen thereby narrowing the diagnostic window.ObjectivesTo explore the implications of enhanced HIV screening methods that may be leading to HIV misdiagnoses.Study designA patient deemed to be an HIV infected 'elite controller' was found to be misdiagnosed when undergoing detailed investigations prior to initiating antiretroviral therapy. A root cause analysis was performed to identify the causative factors of this misdiagnosis. A retrospective review of all “elite controllers” in Alberta, Canada revealed challenges of current HIV testing algorithms.ResultsTechnical and human factors were identified as being causative in this HIV misdiagnosis including (i) high rates of false reactive results on the Abbott ARCHITECT HIV-1&2 COMBO EIA, (ii) human error in reading the initial Western blot, (iii) HIV algorithmic directives in which confirmatory (Western blot) testing was not performed on a repeatedly reactive screen test. The outcome of this analysis identified opportunities for improvement, including implementation of a newly approved (automated) confirmatory assay and improved communication between the clinician and laboratory.ConclusionsHIV testing remains problematic despite significant advances in HIV test performance and algorithm development, presenting new and unexpected issues. Ensuring a high-quality management system including implementation of the latest HIV technologies and algorithms along with human resources and policies are required to minimize the impact of false positive diagnoses, especially in the era of universal screening and 'test and treat' recommendations.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Journal of Clinical Virology - Volume 96, November 2017, Pages 84-88
نویسندگان
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