DIAGNOSTICS, VIRUS DETECTION AND SCREENING

Diagnostics,virus detection and screening
          The high genetic variation of Hiv has important implications for the sensitivity and specificity pf ddiagnostic tests.The isolation of Hiv-1 in 1983 and the development of an antibody test soon thereafter were major breakthroughs. However ,the subsequent identification of Hiv 2 has been the characterization of the highly divergent Hiv 1 group N strains
    .       Reports that infections with these strains were not well detected by commonly used,Hov screening tests in Europe and North America have raised concerns about test sensitivity gor blood transfusion safety as well as for individual diagnosis.Although earlier development and evaluation of different diagnostic tests were based primarily on subtype B strains from N.America and Europe more recent tests ,including rapid tests,are much more sensitive in detecting divergent strains like group O as well as group M subtypes other than subtype B (104)
       Similarly recent versions of assays to quantitive viral load have imroved sensitives to the major Hiv 1 subtype s compared with earlier assays which were primarily based on subtype B sequences (105,106) .In addition to antibody new scrologic testing strategies to detect recent infection and to estimate incidence have also demonstrated different performance characteristics depending on subtype 107
    . 
        Active surveillance for and characterization of the prevailing Hiv strains and essential to validate the sensitivity of Hiv tests in clinical practice and research use .This surveillance may be well be particularly challenging.
            However ,an apparent ly poor outcome may refect initial diagnosis of Hiv/Aids late in the course of infection lack of access to medical care or death,from prevalent opportunistic infections such as TB that occurs relating early in the course of Hivi infection rather than any applicable differences in the rate of decline of immunologic function.

  •          Although, various biological including host immunological factors may hasten Hiv pathogenesis and disease progression,studies do not suggest significant differences in natural history of Hiv 1 infection by sex or racial group.However there is in vitro evidence that different strains may vary in pathogenic potential for instance Hiv isolates vary in their cellular host range and tropism,and some studies have shown that these properties are associated with specific viral genetic and phenotypic changes.

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