PubMed · 3340109
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1988-02-11. Screening for HIV.. https://doi.org/10.1056/nejm198802113180610
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Failure to detect infection with HIV-1 non-B subtypes in some antibody screening assays has been shown. To date, however, no studies have been published evaluating the capacity of standard tests to quantify replication of divergent HIV-1 in cell culture. Reverse transcriptase (RT) activity and p24 antigen assays are the two methods most commonly used for this purpose. A homogeneous panel of HIV-1 subtype B viruses from northern Italy and a heterogeneous panel of diverse genetic subtypes (A to F and O) from different regions of the world were cultured under identical conditions. A new nonradioactive RT assay was used as a basis for comparison to evaluate the capacity of two p24 assays to quantify viral growth in both panels. Comparison of the p24 amount/RT activity (p24/RT) ratios showed that ratios in the subtype B panel tended to be markedly higher than in the diverse subtype panel. Greatest variation was seen with one of the subtype O isolates, where up to a 400 times lower ratio was obtained compared with the average ratio for the subtype B panel. In addition, one Thai subtype B virus also gave a markedly reduced ratio. Furthermore, comparison between the two p24 assays showed different abilities to detect p24 from different HIV-1 isolates. We discuss limitations for the use of anti-HIV-1 p24 antibodies produced by immunization with subtype B p24 in p24 assays.
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OBJECTIVE: To compare the prevalence of drug-resistant tuberculosis disease among patients with and without HIV infection. DESIGN: An historical prospective evaluation of patients with culture-proven tuberculosis reported between January 1988 and December 1995. SETTING: A major metropolitan county public health department. PATIENTS: A total of 802 consecutive culture-positive tuberculosis patients were eligible for inclusion in the study. HIV serologic testing and drug susceptibilities were completed on 741 (92%) eligible patients. Of these patients, 646 tested HIV-negative and 95 (12.8%) tested HIV-positive. Patients not tested for HIV (n = 59) and without drug susceptibilities (n = 2) were excluded from the analyses. Outpatient management was based on a policy of universal directly observed therapy. MAIN OUTCOME MEASURES: Patient HIV status, initial drug resistance and acquired drug resistance. Isolates were characterized for resistance to isoniazid, rifampin, rifabutin, ethambutol, streptomycin, capreomycin, kanamycin and ethionamide. Determination of initial resistance was based on the first available susceptibility study and acquired resistance on subsequent susceptibility studies. RESULTS: Initial drug resistance was found in 55 (8.5%) HIV-negative patients and four (4.2%) HIV-positive patients. Acquired drug resistance occurred in five (0.8%) HIV-negative patients and one (1.1%) HIV-positive patient. These differences were not statistically significant. CONCLUSIONS: HIV infection is not a risk factor for drug-resistant tuberculosis. Increased drug resistance in HIV infected tuberculosis patients reflects a failure of tuberculosis control in the underlying population.