Extensive tests for extermination: Need for incorporation of molecular detection methods of human immunodeficiency virus in screening algorithm in tertiary hospitals in India

CONTEXT: A downward trend is being observed in the incidence of human immunodeficiency virus (HIV) infection in India due to strategic activities of National AIDS Control Organisation (NACO) in the last 24 years. Opt-out testing has consistently shown high seroprevalence in our tertiary care center. AIM: This study aims to audit opt-out testing and compare various commercial test kits used to detect HIV seroprevalence in patients in our tertiary care institute and suggest new algorithm for HIV testing in tertiary hospitals in India. MATERIALS AND METHODS: Retrospective analysis of 30,021 samples tested in Department of Immunopathology using opt-out testing delinked from the NACO-sponsored testing for Integrated Counselling and Testing Centre (ICTC) was performed. Study population comprised of presurgery and emergency patients which at the time of our reporting were not included in ICTC testing. RESULTS: Microlisa was the first test performed on 76% samples. 1.02% cases were reactive only with Microlisa and negative with other rapid kits hence were reported as negative, according to NACO scheme of reporting. Advanced testing algorithm followed by centre for disease control (CDC) showed that 80% of these 4(th)-generation positive and rapid test-negative patients turned out to be acute HIV infections on molecular testing. CONCLUSION: Patients in tertiary referral center constitute high-risk population and should be screened with 4(th)-generation enzyme-linked immunosorbent assay which incorporates p24 antigen. Those which are found indeterminate should have molecular testing by nucleic acid amplification test or real-time polymerase chain reaction, as our study has demonstrated that 1.02% of these cases may harbor acute HIV infection.