Bulletin of the World Health Organization

Low-cost tools for diagnosing and monitoring HIV infection in low-resource settings

Grace Wu & Muhammad H Zaman

Volume 90, Number 12, December 2012, 914-920

Table 2. Characteristics of low-cost tests for diagnosing and monitoring human immunodeficiency virus (HIV) infection

Test purpose, type Commercial test(s) Portable Detection method Cost (US$) Time to result Advantage(s) Limitation(s)
HIV diagnosis
ELISA Many available9 No Quantifies HIV DNA or RNA in serum < 2 ~3–5 hours High throughput, sensitive Requires dedicated laboratory equipment and confirmatory diagnosis, not for early infant diagnosis
Simple/rapid test Many available10 Yes Qualitatively detects HIV antibodies in whole blood, serum or saliva < 2 ~30 minutes Appropriate for screening large and rural populations, immediate result For screening only (not quantitative), not high throughput for larger-scale screening
p24 test Perkin-Elmer p24 Ultrakit11 No Quantifies p24 core protein of HIV 5–10 ~4 hours Sensitive for paediatric diagnosis of HIV infection, cheaper than PCR Requires dedicated laboratory space, additional buffer reagents and further validation
ART initiation, virologic failure
POC CD4+ T-cell count Pima Test; Point-Care NOW; Partec CyFlow miniPOC; Daktari CD4+12 Yes Quantifies CD4+ T-cells ~6 per test 20 minutes (Pima), 8 minutes (Point) Portable, sensitive, faster than flow cytometry Requires further validation, tests CD4+ T-cell count only (Pima Test), not high throughput
POC PCR Liat HIV Quant Assay (in pipeline)12 Yes Quantifies HIV DNA in blood 25 000 per instrument 88 minutes per sample Portable To be determined
Reverse transcriptase test Cavidi EXAVir Load Version 313 No Quantifies reverse transcriptase levels ~20 90 minutes Cheaper than virus load testing, tests for multiple HIV subtypes High rate of false-positive results, long testing time, not POC

ART, antiretroviral therapy; DNA, deoxyribonucleic acid; ELISA, enzyme-linked immunosorbent assay; PCR, polymerase chain reaction; POC, point-of-care; RNA, ribonucleic acid; US$, United States dollars.