AIDS Testing Methodology and Management Issues

Transcription

1 AIDS Testing

2 Gerald Schochetman J. Richard George Editors AIDS Testing Methodology and Management Issues Foreword by Walter R. Dowdle With 38 Illustrations Springer-Verlag New York Berlin Heidelberg London Paris Tokyo Hong Kong Barcelona Budapest

3 Gerald Schochetman, Ph.D. Chief, Laboratory Investigations Branch Division of HlV / AIDS National Center for Infectious Diseases Centers for Disease Control Atlanta, GA USA J. Richard George, Ph.D. Chief, Developmental Technology Section Laboratory Investigations Branch Division of HIV / AIDS National Center for Infectious Diseases Centers for Disease Control Atlanta, GA USA The photograph of microtiter plates used in the cover design was provided by Dr. Gillian Turgeon, Cornell University. Library of Congress Cataloging-in-Publication Data AIDS testing: methodology and management issues 1 Gerald Schochetman, J. Richard George, editors. p. cm. Includes bibliographical references and index. ISBN-13: e-isbn-13: DOl: / AIDS (Disease)-Diagnosis. I. Schochetman, Gerald. II. George, 1. Richard. [DNLM: 1. Aquired Immunodeficiency Syndrome-diagnosis. 2. Acquired Immunodeficiency Syndrome-prevention & control. 3. HIV Infections-diagnosis. 4. HIV Infections-prevention & control. WD 308 A288468] RC607.A26A '92075-dc20 DNLM/DLC for Library of Congress Printed on acid-free paper Springer-Verlag New York, Inc. Softcover reprint of the hardcover 1st edition 1992 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag New York, Inc., 175 Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc. in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. Further, the use of trade names is for identification only and does not constitute endorsement by the Public Health Service or the U.S. Department of Health and Human Services. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Typeset by Best-set Typesetter Ltd, Hong Kong ISBN-13:

4 Foreword The human immunodeficiency virus (HIV) infection and aquired immunodeficiency syndrome (AIDS) continue to present a major challenge to health care professionals and society throughout much of the world. In the United States in 1989, HIV/AIDS became the second leading cause of death among men 25 to 44 years of age and ranked eighth among causes of death in women 25 to 44 years of age. On the basis of current trends, HIV I AIDS is expected to rank fifth among the causes of death in women in this age group in Testing for the AIDS virus has become a cornerstone for surveillance and prevention programs and for provision of appropriate medical care for those who are infected. Current HIV tests are highly accurate. They rank among the best diagnostic tests in use today. The controversy surrounding the tests now stems not from a lack of confidence in their reliability but from the perceived social consequences of an individual being identified as infected with the AIDS virus. With better understanding by the public of HIV infectionl AIDS and a greater acceptance of those who are infected, this attitude can be hoped to change. The public and private health care sectors have an obligation to those who are infected by HIV and those who are at risk of infection. For health care providers who must understand and apply testing for detection, counseling, and care of HIV-infected persons, this book provides a comprehensive overview of the spectrum of issues relating to HIV testing. Available tests are discussed in terms of information that they provide and the application of that information for the benefit of the patient. Other chapters provide guidance for clinical laboratorians on the design and safe implementation of quality HIV testing procedures. This book describes in clear terms all the complex elements of testing, including (i) those who should be offered the tests, (ii) medical and ethical considerations, (iii) the scientific principles of the tests, and (iv) application of the tests to determine immune functions and progress of virus infection. v

5 vi Foreword Testing for HIV is an integral component of disease control, even more so as potential vaccines and new therapies are developed. Remarkable progress has been made in the area of HIV testing. Most recent is the application of the polymerase chain reaction (per) to detect HIV infection and to trace transmission and evolution of the virus. New tests and new procedures undoubtedly will be developed as more is learned about HIV infection and the opportunities for intervention expand, but this book should remain a valuable reference source for years to come. Walter R. Dowdle Deputy Director Centers for Disease Control

6 Contents Foreword by Walter R. Dowdle Contributors v IX l. Testing for AIDS and Other Human Retroviruses: An Overview 1 Gerald Schochetman 2. Testing for Retroviral Infections: Medical Indications and Ethical Considerations 6 John Ward 3. Biology of Human Immunodeficiency Viruses 18 Gerald Schochetman 4. Immunologic Aspects of Human Immunodeficiency Virus Infection 30 Alison C. Mawle and J. Steven McDougal 5. Serologic Tests for the Detection of Human Immunodeficiency Virus Infection 48 J. Richard George and Gerald Schochetman 6. Quality Control for Serologic Testing 79 J. Richard George 7. Direct Detection of Human Immunodeficiency Virus Infection Using the Polymerase Chain Reaction 90 Gerald Schochetman and John J. Sninsky 8. Human Immunodeficiency Virus Culture 111 Mark A. Rayfield 9. Use of Flow Cytometry to Monitor Human Immunodeficiency Virus Disease 123 Alan L. Landay and Betsy M. Ohlsson-Wilhelm vii

7 viii Contents 10. Prognostic Indicators for Progression of Human Immunodeficiency Virus Disease 143 C. Robert Horsburgh 11. Human Immunodeficiency Virus Infection in Children 152 Martha Rogers and Gerald Schochetman 12. Other Human Retrovirus Infections: HTLV-I and HTLV-II 168 Michael D. Lairmore and Renu Lal 13. Biosafety: Principles and Practices in the Human Immunodeficincy Virus Laboratory M. E. Kennedy 14. Management of Occupational Exposure to the Human Immunodeficiency Virus Kenneth G. Castro and Jacquelyn A. Polder Glossary Subject Index

8 Contributors Kenneth G. Castro, M.D., Epidemiology Branch, Division of HIVI AIDS, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA J. Richard George, Ph.D., Chief, Developmental Technology Section, Laboratory Investigations Branch, Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA C. Robert Horsburgh, Jr. M.D., Epidemiology Branch, Division of HIV I AIDS, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA M.E. Kennedy, Chief, Office of Biosafety, Laboratory Center for Disease Control, Health and Welfare Canada, Tunney's Pasture, Ottawa, Ontario, Canada, KIA OL2 Michael D. Lairmore, D.V.M., Ph.D., Department of Veterinary Pathobiology, The Ohio State University, Columbus, OH Renu Lal, Ph.D., Retrovirus Diseases Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA Alan L. Landay, Ph.D., Director, Immunology Laboratory, Office of Consolidated Laboratory Services, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL Alison C. Mawle, Ph.D., Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA ix

9 x Contributors J. Steven McDougal, M.D., Chief, Immunology Branch, Division of HIV I AIDS, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA Betsy M. Ohlsson-Wilhelm, Ph.D., Departments of Medicine and Microbiology and Immunology, The Pennsylvania State University, College of Medicine, Hershey, P A Jacquelyn A. Polder, B.S.N., M.P.H., AIDS Activity, Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA Mark A. Rayfield, Ph.D., Chief, Cell Biology Section, Laboratory Investigations Branch, Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA Martha F. Rogers, M.D., Chief, Epidemiology Branch, Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA Gerald Schochetman, Ph.D., Chief, Laboratory Investigations Branch, Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA John J. Sninsky, Ph.D., PCR Division, Cetus Corp., Emoryville, CA John W. Ward, M.D., Chief, Reporting and Analysis Section, Surveillance Branch, Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA 30333