Every where — chemists have labs , they have all sorts of gadjects . pharmacists have labs, microbiologists have labs, tests are run and interpreted treatment is commenced, most often no conformation, partner may not be notified- a key require if hospital.
Diagnostic centers, patent medicine dealers, Hematology and blood transfusion clinics, Oncology clinics
Centers established and maintained by oil companies
Central or state government hospitals
Voluntary Counseling and testing units. This is the proper thing but …not enough
Primary health care centers, Miscellaneous centers –NGOS, Doctors without bothers (Médecins Sans Frontières (MSF),
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Include the issue of positive becoming negative without an independent confirmation
Under Hospital conditions, you have opportunity to have many other tests done
Assuming Mr A contracts HIV
The ways of manifestation—commonly affected body areas Temperature, high or mild depending on the subtype, comes and goes whether or not you take ABS, weight loss from chronic diarrhea release of protein wasting chemicals—marked reduction in cell mass, mouth diseases, never there before, eye diseases, looking like apolo. But with much redness and plenty of gummy discharge—salad cream and tomato ketchup retinopathy(opthalmoscopy), skin manifestations-boils and weeping lesions, Heart diseases, All Parts Of The Heart, Git , Blood, Kidney problems, coinfection with hepatitis, joint , disorders of blood pressure and sugar control, Brain tissue, Neuro psychiatric Poblems. Pseudomembranous type oral candidiadis angular cheilosis. Note presence of odynophagia
Xerostomia-dry Mouth, Marked Reduction In The Quantity Of Saliva Expressed From Whartsons Or Stensons Ducts
Chest——Pneumocystic pneumonia or pulmonary TB, Cryptococcosis, Toxoplasmosis, Syphilis, Cytomegalovirus infection, Herpes simplex, Varicella-Zoster, Candidiasis, particularly oral candida
AIDS defining cancer——Karposis Sarcoma including asymptomatic oral KS, and AIDS related Lymphoma
What may inform the need to run HIV/AIDS test?
There are a number of situations that may warrant lab tests for HIV/AIDS
Routine…..Before any surgery, pregnancy (ANC), endoscocopy, laparoscopy, dialysis (including ambulatory), requirements for marriage , artificial reproduction procedures, before transfusion of blood or blood products, blood and organ donation, cases of rape to establish pre incubation period status.
When clinical conditions emerge that point in the direction of AIDS including… Diagnosis in children for other problems as for instance failure to thrive often reveals the presence of the virus in the family
Whether or not the tests are carried out in Nigeria false positive results can occur as the following account ,one of many cases will demonstrate
Elute Dartinma(not her real name) is a beautiful young Nigerian female in her early thirties , properly married to a civil servant . Suspicious of her social and subterranean activities since her business became international, her husband requested they went for HIV/AIDS voluntary counseling and testing .they went to where they had reasons to believe was a very reliable place. They didn’t have counseling but someone gave them some explanations and the results came out after a few hours. Her husband was seronegative. She was positive, They were told the lab had facilities for confirmatory tests not any other one that they knew of. Because during her numerous trips overseas she had succumbed to a particularly overwhelming temptation, she felt God had decided she would be punished. She accepted the results . her husband went berserk and invited members of both sides of the family . They sent her out with the instruction never to come near her son and daughter 8 and 5 respectively. At first she wanted to take her life, but thought about her beautiful kids. She drew nearer to God and believed that the reason why she was not manifesting was purely by the mercy of God. After six years she met someone during a meeting of people with a supposedly similar condition. She had now known what other tests, someone with HIV/AIDS needed to do but since she never had repeat counseling, she avoided labs so she did not have to hear her condition had gone for the worst. She and her new man continued to have unprotected sex until she saw a dentist who insisted on her doing a lab test before tooth extraction. Unlike her previous lab test, this one combined six tests- including white blood cells and CD4 counts; she was seronegative and her CD4 count was 800 (normal range 500-1000) cells/µL. In a shocked state, she begged the Dentist to accompany her and observe as the procedure was repeated. Three additional confirmatory tests were done and except for small differences in the CD4 count, she was seronegative.
Reasons why we are where we are
•Tests may be sensitive—able to detect the AIDS virus but most of them are not specific, and can cross react to detect other viruses . well trained laboratory scientists are able to detect ….
•Retroviruses, in particular those that infect humans are unstable; they can be easily made inactive or killed by detergents, Savlon, alcohol, bleach and heat, usually obtainable in the laboratory
•Though in asymptomatic individuals the proportion of infected CD4 positive T cells is in the range 1 in 100 to 1 in 10,000, at least one or two viral particles can be detected in every 100 CD4 –positive T-cells by the time patients present with AIDS.
•Catastrophising or fear avoidance behavior….
•A center may be a catastrophist , so he can sell his drugs and attract more clients and patients
Tests based on the p24 core antigen can pick it up in blood samples 3-6 weeks after infection, but may become borderline positive or even negative after 6 months , after which it now becomes positive once again.
•Counseling techniques specific for HIV/AIDS may not yield good results if the knowledge base of the counseling official is narrow or inadequate. Medical and social history may not detect the presence of co morbidities. Therefore in patients who are chronic alcoholics, with liver disease(alcoholic Hepatitis), healthy people who have had repeated transfusion of blood and blood products, chronic intravenous drug users, who share needles, discordant couples, non progressors(long term and sort term). Positive results have to be carefully interpreted and confirmation is essential .
•Most HIV /AIDS infection involves type 1 and type 2 variants of the virus,, type I being more pandemic and of world wide spread compared with type 2 which is more an African Disease,
and each has its own sub types with characteristics not exactly known. Beyond that, only type 1 has been well studied. What is known about the history and clinical course of HIV TYPE 2 at the moment is based on assumptions and not evidence. Physicians and laboratory professionals in resource limited countries therefore face more challenges when they have to make a diagnosis In patients with advanced stages of AIDS when equipment such as PCR are not available , or purchased at inflated price and no trained personnel to use and maintain them
•When it is indicated to detect HIV infections in adult patients with results marked negative but to repeat, bother line or indeterminate or in neonates born to HIV/AIDS positive mothers , cultures are the test of choice, only few centers are currently doing this because of issues of technique and safety
Secondly using reverse transcriptase assay, though capable of detecting the subtypes .the machine requires a great deal of expertise to operate.
•Time duration from collection to analysis
Antibody-based assays (e.g., ELISA and rapid tests) are simple, cheap, and highly accurate tools for diagnosing HIV infection in adults and in children older than 18 months of age.
However, in infants and children under 18 months of age, these tests cannot differentiate between persistent maternal HIV antibodies transferred across the placenta into the baby’s circulation (i.e., HIV exposure) and HIV antibodies produced by the child (i.e., HIV infection).
All babies born to HIV-positive women will have a positive HIV antibody detection test result at birth.
This result may remain positive until up to 18 months of age, though more commonly it becomes negative (seroreverts) in an HIV-uninfected infant much earlier.
In children younger than 18 months, HIV antibody detection assays can be useful, provided the results are correctly interpreted.
If the child tests positive, HIV exposure is confirmed.
Exposed children require specific care (e.g., prophylactic cotrimoxazole, infant feeding counseling) and further testing to establish their HIV infection status.
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