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Essential Diagnostics for Advanced HIV Disease

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

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Essential Diagnostics for Advanced HIV Disease

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  1. Essential Diagnostics for Advanced HIV Disease WhyneedPneumocystis PCR Jahit Sacarlal 12 April 2017

  2. 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%

  3. Available commercial kits: • Pneumocystis jirovecii (Bio-Evolution);  • Pneumocystis carinii Real Time PCR Kit (Shanghai ZJ Bio-Tech, BioProducts AT, Clongen or Vacunek); • AmpliSensPneumocystis 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).

  4. Data we have for PCR PCP (Sens/Speci) • Compare with IF using BAL (100/98) orSputum (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)

  5. 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

  6. 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

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