Essential Diagnostics for Advanced HIV Disease

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Presentation transcript:

Essential Diagnostics for Advanced HIV Disease Why need Pneumocystis PCR Jahit Sacarlal 12 April 2017

Why Need? Burden: around ½ million patient Overall mortality: 20-80% We can save in 5 years around 500,000 people The rate/100000 varies from 48-0,4 cases Variety of stains (Giemsa, Diff-Quick, Gomori methenamine-silver (GMS), toluidine O blue, and fluorescein-conjugated monoclonal antibodies, all showing variable levels of sensitivity (45–92%) PCR with sensitivity values ranging from 86% to 100%

Available commercial kits: Pneumocystis jirovecii (Bio-Evolution); Pneumocystis carinii Real Time PCR Kit (Shanghai ZJ Bio-Tech, BioProducts AT, Clongen or Vacunek); AmpliSens Pneumocystis jirovecii (carinii) FRT PCR; RIDA-GENE Pneumocystis jirovecii (R-Biopharm AG); Pneumocystis jirovecii FTD (Fast-Track Diagnostics); Progenie kits (Progenie Molecular); reagents for BD MAXTM system Pneumocystis jirovecii (BioGX). Also available are non-approved kits such as LightMix Kit Pneumocystis jirovecii (TIB MOLBIOL); MycoReal Pneumocystis (ingenetix GmBH) and Pneumocystis jirovecii Path-P (PrimerDesign Genesig).

Data we have for PCR PCP (Sens/Speci) Compare with IF using BAL (100/98) or Sputum (92/98) Compare with microscopy use BAL (100/100) or Oropharyngeal (79/100) or oral wash (88/85)(90/100) Compare with IF use induced sputum (85/96)

Limitation of PCR PCP Only for diagnostic test – detects organism, does not always define disease Still require infrastructure with lab level 2/3 and with stable electricity power Need continue use Machines for PCR Useful samples are BAL, Oropharyngeal and maybe Oral Wash Need continue training capacity Need fridge and freezer Take more time compared with other rapid test PCR Machine need running at room temperature For shipping reagents and samples need ICE Cost for test is high

Recommendation Appropriate for MIC tertiary/specialist hospitals In LICs Use only in Reference/Central Lab or Research Lab Need more Research for find new generation of PCR Need transferring the technique to LIC and MIC