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Title Detection of HIV Antibodies Through Oral Fluid Samples is a Reliable Method to Diagnose HIV+ Individuals in Communities with High HIV Prevalence
Clinical Question Is the oral salivary antibody test as effective as the gold standard, ELISA/Western blot, in diagnosing HIV+ individuals?
Clinical Bottom Line Rapid oral salivary tests are reliable diagnostic tools in communities with a high prevalence of HIV+ individuals.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22277215Pai/2012A meta-analysis: subjects pooled from 61 studiesSystematic review/ Meta-analysis
Key resultsMeta-analysis of the studies revealed a higher PPV, 98.6%, of oral salivary tests in communities with a high prevalence (>1%) of HIV+ individuals. A lower PPV, 88.5%, was found in a prevalence of <1% of HIV+ individuals.
#2) 21396537Iregbu/2010645 patients divided into 3 groups of 215 known HIV+, 228 low risk, and 202 high risk individualsComparison of diagnostic tests to the gold standard
Key resultsOral salivary tests had a sensitivity and specificity of 100%, whereas finger stick blood tests had a sensitivity of 100% and a specificity of 95% when compared to the gold standard- Western Blot.
#3) 22871032Zachary/20124,485 patients from 12 high prevalence communities in ZambiaComparison of diagnostic tests
Key resultsOral salivary tests had a sensitivity of 98.7%, specificity of 99.8%, PPV of 99.1% and NPV of 99.8%.
Evidence Search (("mouth"[MeSH Terms] OR "mouth"[All Fields] OR "oral"[All Fields]) AND ("hiv"[MeSH Terms] OR "hiv"[All Fields]) AND ("research design"[MeSH Terms] OR ("research"[All Fields] AND "design"[All Fields]) OR "research design"[All Fields] OR "test"[All Fields])) AND ("sensitivity and specificity"[MeSH Terms] OR ("sensitivity"[All Fields] AND "specificity"[All Fields]) OR "sensitivity and specificity"[All Fields])
Comments on
The Evidence
Validity: Pai’s systematic review evaluated numerous studies that reported efficacy of oral salivary tests and ELISA with whole blood and/or immunofluorescence assays. The studies were divided into three subgroups: (1) head-to head comparisons of oral salivary and whole blood tests, (2) reports of oral salivary tests alone, (3) reports of whole blood tests alone. The exclusion criteria were studies in children, studies in co-infected populations, studies with self-reported inferior reference standards and incomplete reporting of key data. The statistical tests used to calculate the PPV of the oral salivary tests was random effects bivariate regression analysis. A prevalence of >1% was considered high. Iregbu’s study compared oral salivary tests and serum antibody tests to the Western Blot. The oral salivary test had a higher specificity compared to the serum test. The study includes known HIV+ individuals who were on HAART therapy, high risk individuals and low risk individuals. Zachary’s study did not use the gold standard to compare the diagnostic capabilities of the oral salivary test. There were no known HIV+ individuals included in the study. For each individual the oral salivary test and rapid serum antibody test was interpreted by the same person and may have resulted in incorporation bias. Perspective: The sensitivity, specificity and PPV reported by the studies make the non-invasive salivary test a reliable method of diagnosing HIV+ individuals.
Applicability Oral salivary tests provide efficient and non-invasive means in diagnosing HIV; however, its reliability is reduced when used in communities with lower prevalence of HIV (1%). The high cost and lower PPV in developed countries are two major limitations of the test. The use of the tests in regions with a high prevalence (>1%) is promising and present a rapid system to identify individuals in need of treatment.
Specialty/Discipline (Public Health) (Oral Medicine/Pathology/Radiology) (General Dentistry) (Basic Science) (Dental Hygiene)
Keywords HIV diagnosis, oral salivary test, ELISA, Western Blot
ID# 2544
Date of submission: 08/06/2013spacer
E-mail villamayor@livemail.uthscsa.edu
Author Aimee Villamayor
Co-author(s) Paul Michael Russell
Co-author(s) e-mail RussellP@UTHSCSA.edu
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