应用斑点金免疫渗滤试验快速同步检测抗HIV-1,HIV-2 IgG抗体

应用斑点金免疫渗滤试验(dotimmunogoldfiltration assay,DIGFA)建立了一种同步快速检测四种抗HIV-1/2IgG抗体的HIV诊断试纸.通过基因工程技术在大肠杆菌中表达了5种HIV抗原蛋白片段(P24,GP41,GP36,GP120V3,GP120C).这5种抗原蛋白首先被固定在硝酸纤维素膜上,然后滴加待测血清,其中的病毒抗体通过免疫反应与抗原结合,再加胶体金标记的葡萄球菌蛋白A(SPA),待其渗过膜片后,洗涤,即可形成肉眼可见的红色斑点.用已确证的21份HIV阳性血清(其中包括1份HIV-1标准阳性血清和1份HIV-2标准阳性血清)和30份阴性血清进行了试验,结果表明该快速检测方法与ELISA方法无显著差异.该检测方法不需任何仪器,仅凭肉眼即可判定结果,整个检测过程不超过5分钟.与传统的的ELISA法相比,具有方便快速,成本低廉,应用范围广等优点.同时,此HIV快速诊断试纸可以同步检测并区分针对HIV-1和HIV-2感染的不同检测标志物(抗P24、GP41、GP120和GP36抗体),这对提高快速检测的灵敏度和准确性,以及对判断HIV感染者是否临近或已进入AIDS期有着较高的应用价值.     

双抗体夹心ELISA检测HIV-1 gp41抗原方法的建立

目的:建立检测HIV-1gp41抗原的双抗体夹心ELISA,并探讨其临床应用的可行性。方法:用饱和硫酸铵(SAS)纯化抗HIV-1gp41-5单克隆抗体(mAb),用HRP标记后建立双抗体夹心ELISA法,对其灵敏度及特异性进行检测,并用该方法对40份HIV-1阳性血清进行了检测。结果:用mAbE12(5μg/mL)为包被抗体,2H6为酶标记抗体(1∶900)建立了双抗体夹心ELISA法,检测gp41-5多肽的灵敏度是100pg/mL。对HIV-1阳性血清中gp41抗原的检出率为67.5%(27/40)。结论:建立了特异性强、灵敏度良好的检测HIV-1gp41抗原的双抗体夹心ELISA法。     

应用斑点金免疫渗滤试验快速同步检测抗HIV-1，HIV-2 IgG抗体

应用斑点金免疫渗滤试验(dotimmunogoldfiltrationassay,DIGFA)建立了一种同步快速检测四种抗HIV-1/2IgG抗体的HIV诊断试纸。通过基因工程技术在大肠杆菌中表达了5种HIV抗原蛋白片段(P24,GP41,GP36,GP120V3,GP120C)。这5种抗原蛋白首先被固定在硝酸纤维素膜上,然后滴加待测血清,其中的病毒抗体通过免疫反应与抗原结合,再加胶体金标记的葡萄球菌蛋白A(SPA),待其渗过膜片后,洗涤,即可形成肉眼可见的红色斑点。用已确证的21份HIV阳性血清(其中包括1份HIV-1标准阳性血清和1份HIV-2标准阳性血清)和30份阴性血清进行了试验,结果表明该快速检测方法与ELISA方法无显著差异。该检测方法不需任何仪器,仅凭肉眼即可判定结果,整个检测过程不超过5分钟。与传统的的ELISA法相比,具有方便快速,成本低廉,应用范围广等优点。同时,此HIV快速诊断试纸可以同步检测并区分针对HIV-1和HIV-2感染的不同检测标志物(抗P24、GP41、GP120和GP36抗体),这对提高快速检测的灵敏度和准确性,以及对判断HIV感染者是否临近或已进入AIDS期有着较高的应用价值。     

核酸定量检测试验应用于HIV-1感染实验室诊断的探讨

目的:探讨核酸定量检测在HIV-1感染实验室诊断中的应用。方法:选取145例第四代抗原/抗体联合诊断筛查试验为阳性反应的血浆样本,分别用Western印迹和HIV-1核酸定量方法进行检测,综合对比分析2种方法检测结果。结果:Western印迹检出阳性样本120例,不确定样本17例,阴性样本8例;HIV-1核酸定量试验检出结果大于检测限样本131例,其中包括12例Western印迹不确定样本、2例Western印迹阴性样本;有3例Western印迹阳性样本用HIV-1核酸定量检测试验未能检出。结论:核酸定量检测试验对于HIV-1感染阳性样本是一种有效的实验室诊断方法;对HIV-1核酸定量检测结果为"TND"的样本,建议加做Western印迹或结合其他补充试验结果进行综合诊断。     

HIV-1 p24蛋白在大肠肝菌中的高效可溶性表达、一步纯化及抗原性分析

合成引物扩增HIV-1 p24基因,并将其克隆到pQE-30质粒中,使其在大肠杆菌E.coli M15中以IPTG诱导高效表达,经SDS-PAGE分析,该表达产物约占菌体总蛋白20%,并且以可溶蛋白的形式存在于细菌裂解液上清之中.经镍离子柱亲和层析一步纯化,洗脱产物中p24蛋白纯度达95%.ELISA分析表明,该蛋白可与HIV感染者血清发生特异性免疫反应.以此蛋白交联Sepharose 4B,亲和层析纯化HIV感染者血清中的抗体,用所得抗体与HIV确认试剂反应,发现该纯化抗体仅与确认试剂中的p24蛋白反应.上述结果表明在大肠杆菌中已经高效表达了可溶性HIV-1 p24蛋白,该蛋白具有良好的抗原性.     

啮齿类动物中汉坦病毒感染血清学和病原学检测方法比较研究

致病性汉坦病毒的宿主主要为啮齿类动物,其病毒感染状况是人间疫情发生的关键影响因素,可通过检测宿主动物标本中病毒基因组RNA、蛋白抗原及特异性抗体而进行监测。本研究利用367份鼠肺及鼠血标本,对双抗原夹心ELISA(ELISA)、实时荧光RT-PCR(RT-PCR)和免疫荧光(IFA)等三种分别检测抗体、核酸和抗原的方法进行比较评估。ELISA法检出抗体阳性鼠血标本46份,阳性率为12.53%;RT-PCR法检出病毒RNA阳性鼠肺标本28份,阳性率为7.63%;IFA检出抗原阳性鼠肺标本24份,阳性率为6.54%。宿主动物组织标本中检出汉坦病毒RNA和(或)结构蛋白抗原的标本,对应的血液标本中可检出病毒特异性抗体,100%(24/24)IFA检测阳性标本和89.3%(25/28)RT-PCR检测阳性标本对应血标本ELISA抗体检测阳性,反之亦然,检出抗体的标本基本包含了可检出抗原和RNA的标本。RT-PCR与IFA检测结果差异无显著性(χa2=0.64,P0.05),一致性检验Kappa系数为0.71,一致性高(Z=13.66,P0.05),首先对血标本开展基于ELISA的特异性抗体检测,可显著缩小RT-PCR或IFA法检测病毒RNA或抗原的范围(χb2=12.04,χc2=20.05,P0.05)。本研究为宿主动物汉坦病毒感染实验室监测方案优化提供了有益的依据。     

HIV-1B亚型gp120基因密码子优化前后免疫原性的比较

对HIV-1B亚型gp120基因按照哺乳动物优势密码子的使用原则进行优化,以Westem blot方法比较其体外表达量.将优化前的野生型gp120基因和改造后的modgp120基因插入重组腺伴随病毒载体,构建了重组病毒rAAV-wtgp120和rAAV-modgp120,比较两者免疫Balb/C小鼠后的抗体和CTL应答.Western blot检测结果显示:优化后基因的体外表达量明显高于野生型基因,rAAV-modgp120与rAAV-wtgp120相比可更好地诱导Balb/C小鼠的CTL应答,但检测不到明显的抗体反应.由此得出结论,优化后gp120基因的体外表达量明显高于野生型基因,并且可以诱导更强的特异性CTL应答,但检测不到gp120抗体.     

一例艾滋病痴呆综合征病人HIV-1 gp120基因多样性及生物学活性位点分析

为探讨人类免疫缺陷病毒1型HIV-1 gp120基因多样性和生物学活性位点与艾滋病痴呆综合征之间的关系,从一例艾滋病痴呆综合征病例尸检标本的淋巴结和中枢神经组织(大脑5个部位:颞叶灰/白质连接处、脑室周围组织、脉络丛、枕叶白质及枕叶灰/白质连接处)提取不同组织来源的基因组DNA,经PCR法扩增HIV-1 gp120基因,经克隆后挑选阳性克隆菌株,对插入片段进行测序。用生物学软件处理并绘制系统发生树,分析糖基化位点,计算ds/dn值,分析V3顶端四肽及关键位点的氨基酸。结果显示,该病人感染的病毒是HIV-1B亚型;分离自不同组织的HIV-1 gp120基因存在差异;与标准序列相比,分离自该病人的HIV-1 gp120基因的部分生物学活性位点存在改变,且源自外周淋巴组织与中枢神经组织的HIV-1 gp120基因中部分生物学活性位点也存在差异。结果表明,HIV-1 gp120基因多样性及与脑组织相关的某些生物学活性位点的改变可能与艾滋病痴呆综合征的发病机制存在一定关系。     

表达HIV-1 CRF01＿AE亚型结构基因小鼠模型的建立和鉴定

目的:构建并鉴定表达HIV-1 CRF01_AE亚型结构基因的小鼠模型。方法:使用哺乳动物密码子优化的HIV-1 CRF01_AE gp160基因,通过慢病毒包装系统构建重组慢病毒LV-GFP-AE gp160,将上述重组慢病毒感染小鼠肺上皮细胞TC-1,经嘌呤霉素抗性筛选获得稳定表达gp160基因的TC-1细胞。采用RT-PCR、流式细胞术检测gp160基因在细胞内的表达稳定性,将稳定表达Gp160蛋白的TC-1-HIV AE gp160细胞接种小鼠,用免疫组化方法检测小鼠体内细胞团块中HIV Gp160蛋白的表达。结果:菌落PCR、酶切鉴定和测序表明重组质粒pLVX-AE gp160构建正确,RT-PCR、GFP荧光及流式细胞术结果均显示gp160基因能在细胞TC-1中稳定表达,免疫组化结果也表明小鼠体内接种的细胞可以稳定表达HIV Gp160蛋白。结论:建立了稳定表达HIV-1 CRF01_AE亚型Gp160蛋白的TC-1细胞及小鼠模型,为HIV-1 CRF01_AE亚型HIV疫苗的临床前研究提供了可靠的体外、体内免疫原性评价工具,为该疫苗的进一步开发奠定了坚实的实验基础。     

携带HIV-1抗原的单纯疱疹病毒载体疫苗的构建及鉴定

利用细菌人工染色体技术将串联的HIV-1 gp160、gag和protease基因以及表达元件插入1型单纯疱疹病毒(Herpes simplex virus type 1,HSV-1)内部反向重复序列区,以获得携带HIV-1抗原的单纯疱疹病毒载体疫苗。首先将HIV-1 gp160(B型和C型)、gag和protease基因串联克隆入pc DNA3获得重组质粒pc DNA/g Bgp和pc DNA/g Cgp,重组质粒转染293FT细胞,Western blotting检测HIV抗原表达。继而将pc DNA/g Bgp和pc DNA/g Cgp中包括HIV-1抗原基因和表达元件的表达框克隆入p KO5/BN获得重组穿梭质粒p KO5/BN/g Bgp和p KO5/BN/g Cgp,穿梭质粒电转含BAC-HSV的大肠杆菌,筛选重组菌,提取重组DNA并转染Vero细胞,挑取病毒蚀斑纯化重组病毒,Southern blotting鉴定重组病毒DNA,Western blotting检测重组病毒感染细胞中HIV抗原表达,并分析病毒的增殖特性。结果表明,Western blotting在pc DNA/g Bgp和pc DNA/g Cgp转染的293FT细胞中检测到表达的gp160和gag蛋白。p KO5/BN/g Bgp和p KO5/BN/g Cgp分别电转获得重组菌,并从重组DNA转染的Vero细胞中纯化获得重组HSV,Southern blotting检测表明重组HSV基因组发生特异性重组,重组病毒感染细胞中检测到gp120和gp41,且重组HSV保留了在哺乳动物细胞中的复制能力。本研究获得携载HIV-1 gp160、gag和protease基因的重组HSV,并保留了在哺乳动物细胞中的复制能力,可作为HIV-1复制型病毒载体疫苗。     

Prevalence of HIV Indeterminate Western Blot Tests and Follow-up of HIV Antibody Sero-Conversion in Southeastern China

HIV-indeterminate Western blotting(WB) results are typically obtained in WB confirmatory assays, and the number of indeterminate samples may increase with the detection of HIV infections, which will present considerable challenges for the management of HIV/AIDS. Nucleic acid detection has been used as a laboratory test for screening suspected or indeterminate samples. However, the effectiveness of these assays for the differential diagnosis of HIV-indeterminate WB samples remained undetermined. In this study, 210 subjects with HIV-indeterminate WB results were detected from 6360 positive HIV screening samples between 2015 and 2016 in southeastern China, in which HIV-indeterminate WB results accounted for 3.30%. The highest proportion of indeterminate results was observed in pregnant and lying-in women receiving physical examinations(16.67%), followed by that in voluntary blood donors(8.82%). The most common WB band patterns were p24, gp160 and p24, and gp160. The follow-up study revealed that the highest negative and positive conversion rates of HIV antibodies were in samples with a single p24 band(80.28%), and with gp160 and p24 bands(86.21%), respectively. Among the Env, Gag, and Pol antibodies, samples with a Gag band showed the highest negative conversion rate(81.25%), whereas the highest positive conversion rate was observed in samples with an Env band(56.76%). In addition, quantitative and qualitative HIV nucleic acid testing exhibited the highest sensitivity(96.3%) and specificity(97.85%), respectively. Our results indicate a lower proportion of HIV indeterminate WB results in southeastern China compared to previous reports, and the follow-up re-examination of patients with HIV indeterminate results should be performed. Nucleic acid testing facilitates the identification of HIV infections.     

Evaluation of the Bio-Rad Geenius HIV 1/2 Confirmation Assay as an Alternative to Western Blot in the Korean Population: A Multi-Center Study

Recently updated recommendations for diagnosis of HIV infection suggest a new diagnostic algorithm including HIV-1/HIV-2 antibody differentiation immunoassay instead of western blot (WB) as a confirmatory testing. We evaluated Bio-Rad Geenius HIV1/2 confirmation assay as a simple and reliable alternative to WB in the Korean population with low HIV prevalence. The Geenius HIV1/2 was performed in a total of 192 serum specimens (140 reactive and 52 nonreactive specimens by ARCHITECT HIV Ag/Ab Combo assay) that were prospectively collected from five institutions. HIV-1 nucleic acid amplification test (NAT) was performed in negative or indeterminate specimens by Geenius HIV1/2 or WB. Among 140 reactive specimens by HIV Ag/Ab assay, 82 (58.6%) were positive for HIV-1 Ab by Geenius HIV1/2. Among 58 negative or indeterminate specimens by Geenius HIV1/2, four specimens (6.9%) were positive by HIV-1 NAT. The sensitivity and specificity of Geenius HIV1/2 were 95.3% and 100.0%, respectively. When we considered only WB, the sensitivity and specificity of Geenius HIV1/2 were 100.0% and 99.1%, respectively. Agreement between Geenius HIV1/2 and WB was excellent (weighted Kappa = 0.89). The Geenius HIV1/2 is simple and time-saving compared with WB. It has an excellent performance and can be a reliable alternative to WB. HIV-1 NAT should be performed in negative or indeterminate specimens by Geenius HIV1/2 to detect acute HIV infection as recommended in new HIV testing algorithms.     

A rapid screening test for HIV-1 antibodies: application to biological studies on human tissue

Human umbilical cord vessels are commonly used as a source of human vascular tissue for physiological studies and as a source of endothelial and smooth muscle cells. Blood samples from 236 umbilical cords were tested for the presence of HIV-1 antibodies to access the prevalence of HIV-1 infection and to evaluate possible methods for screening umbilical cords. Ten of the 236 samples were HIV-1 antibody positive by ELISA whereas 3 were positive by Western blot and a new method, the Quick-Western blot. Two of the 3 positive samples contained antibody bands against gp160, gp120, gp41, and p24 HIV-1 proteins, and one sample had antibodies against only gp160, gp120 and gp41. The Quick-Western blot required only 45 minutes for the analysis while the ELISA and Western blot took 3 hours and 18 hours, respectively. These data indicate that HIV-1 infection in mothers may present a hazard to researchers using human umbilical cords as a source of vascular tissue. The Quick-Western blot method is a simple, portable, rapid and accurate method that may be used to screen blood. The short analysis time of the Quick-Western blot allows the identification of infected blood before the tissue deteriorates as a source of cells or vascular tissue for experimental studies.     

HIV-1 gp160多表位嵌合基因的构建及表达蛋白的免疫原性分析

HIV感染引起的AIDS已经成为严重影响人类健康和社会发展的全球性疾病。酶联免疫吸附试验和免疫印迹检验组合则被认为是HIV检测的“金标准”。因此本实验构建gp160的抗原多表位融合基因及在原核系统的高表达, 为HIV抗体测定提供特异、价廉的抗原。选定HIV-1 gp160基因中三个片段包含较多抗原表位的区域, 设计带有酶切位点的引物,用PCR的方法从HIV-1HXB2全基因扩增编码这三个片段的基因序列,通过质粒提取、酶切、测序方法鉴定基因片段的正确性, SDS-PAGE和Western Blot测定融合蛋白的抗原特异性。构建的HIV-1 gp160多表位嵌合基因的原核表达质粒,酶切和测序结果表明基因序列正确,基因全长969bp。在大肠杆菌BL21(DE3) 中高效表达的重组蛋白分子量为37kDa,以包涵体的形式存在。应用western blot测定10例正常人和12例HIV/AIDS病人血浆显示HIV-1 gp160多表位融合蛋白具有良好的抗原特异性。成功构建了高表达 HIV-1 gp160多表位蛋白的原核表达系统,纯化的融合蛋白有较强的抗原特异性。     

用蛋白印迹确认实验检查"人类免疫缺陷病毒抗体不确定"结果的分析

目的 探讨蛋白印迹实验(WB)“人类免疫缺陷病毒(HIV)抗体不确定”结果的特点、产生的原因、WB确认实验存在的问题及可能的改善措施。方法 归纳分析本实验室2004～2005年的WB检测结果为“HIV抗体不确定”者的人群分布特点、实验检测特点、受检者随访复检及抗体转归情况。结果 “HIV抗体不确定”者人员构成中相对健康的自愿咨询检测者、献血员以及孕产妇占50%,“HIV抗体不确定”者随访困难、复检率较低;WB实验存在假阳性、尤以P24带较为严重。结论 “HIV抗体不确定”结果与WB实验的假阳性有关,实验室应采取应对措施尽可能减少“HIV抗体不确定”及对结果进行准确解释。     

重组HIV-1抗原的应用及评价

将纯化的基因重组HIV-1P24和融合蛋白P24-gp41包被微孔板,用ELISA分别检测正常人血清和HIV-Ab国家参比品（Panel),rP24对20份HIV-Ab阳性Panel的检出率为95%（19/20）,对20份HIV-Ab阳性Panel通过率为90%（18/20）,P24-gp41对20份HIV-Ab阳性Panel检出率为90%（18/20）,对20份HIV-Ab阴性Panel的通过率为60%（12/20）;rP24和P24-gP41对正常人血清的检测结果均为阴性,结果表明研制的P24具有较高的敏感性和特异性,可作为组份抗原用于HIV抗体诊断试剂盒的生产。     

Screening acute HIV infections among Chinese men who have sex with men from voluntary counseling & testing centers

Background

Recent studies have shown the public health importance of identifying acute HIV infection (AHI) in the men who have sex with men (MSM) of China, which has a much higher risk of HIV transmission. However, cost-utility analyses to guide policy around AHI screening are lacking.

Methodology/Principal Findings

An open prospective cohort was recruited among MSM living in Liaoning Province, Northeast China. Blood samples and epidemiological information were collected every 10 weeks. Third-generation ELISA and rapid test were used for HIV antibody screening, western blot assay (WB) served for assay validation. Antibody negative specimens were tested with 24 mini-pool nucleic acid amplification testing (NAAT). Specimens with positive ELISA but negative or indeterminate WB results were tested with NAAT individually without mixing. A cost-utility analysis of NAAT screening was assessed. Among the 5,344 follow-up visits of 1,765 MSM in 22 months, HIV antibody tests detected 114 HIV chronic infections, 24 seroconverters and 21 antibody indeterminate cases. 29 acute HIV infections were detected with NAAT from 21 antibody indeterminate and 1,606 antibody negative cases. The HIV-1 prevalence and incidence density were 6.6% (95% CI: 5.5–7.9) and 7.1 (95% CI: 5.4–9.2)/100 person-years, respectively. With pooled NAAT and individual NAAT strategy, the cost of an HIV transmission averted was $1,480. The addition of NAAT after HIV antibody tests had a cost-utility ratio of $3,366 per gained quality-adjusted life year (QALY). The input-output ratio of NAAT was about 1∶16.9.

Conclusions/Significance

The HIV infections among MSM continue to rise at alarming rates. Despite the rising cost, adding pooled NAAT to the HIV antibody screening significantly increases the identification of acute HIV infections in MSM. Early treatment and target-oriented publicity and education programs can be strengthened to decrease the risk of HIV transmission and to save medical resources in the long run.     

Characterization of Humoral Immune Responses against Capsid Protein p24 and Transmembrane Glycoprotein gp41 of Human Immunodeficiency Virus Type 1 in China

The objective of this study was to extend our previous research and to further characterize the humoral immune responses against HIV-1 p24, gp41 and the specific peptides carrying the immunodominant epitopes (IDEs) that react with human serum samples from HIV-1-infected individuals in China. We found that the majority (90.45%, 180/199) of the samples did not react with any of the three HIV-1 p24 peptides carrying IDEs, but did react with the recombinant full-length p24, suggesting that these samples tested in China were primarily directed against the conformational epitopes of HIV-1 p24. In contrast, 84.54% (164/194) of the samples reacted with at least one HIV-1 linear gp41 peptide, in particular the gp41-p1 peptide (amino acids 560–616). Both recently and long-term HIV-1-infected individuals displayed similar humoral immune responses against the recombinant gp41. However, samples from long-term HIV-1-infected subjects but not from recently infected subjects, showed a very strong reaction against the gp41-p1 peptide. The different response patterns observed for the two groups against the gp41 and the peptide gp41-p1 were statistically significant (P<0.01, Chi-square test). These results have direct relevance and importance for design of improved HIV-1 p24 detection assays and the gp41- based immunoassay that can be used to reliably distinguish recent and long-term HIV-1 infection.     

The Evaluation of a Rapid In Situ HIV Confirmation Test in a Programme with a High Failure Rate of the WHO HIV Two-Test Diagnostic Algorithm

Background

Concerns about false-positive HIV results led to a review of testing procedures used in a Médecins Sans Frontières (MSF) HIV programme in Bukavu, eastern Democratic Republic of Congo. In addition to the WHO HIV rapid diagnostic test algorithm (RDT) (two positive RDTs alone for HIV diagnosis) used in voluntary counselling and testing (VCT) sites we evaluated in situ a practical field-based confirmation test against western blot WB. In addition, we aimed to determine the false-positive rate of the WHO two-test algorithm compared with our adapted protocol including confirmation testing, and whether weakly reactive compared with strongly reactive rapid test results were more likely to be false positives.

Methodology/Principal Findings

2864 clients presenting to MSF VCT centres in Bukavu during January to May 2006 were tested using Determine HIV-1/2® and UniGold HIV® rapid tests in parallel by nurse counsellors. Plasma samples on 229 clients confirmed as double RDT positive by laboratory retesting were further tested using both WB and the Orgenics Immunocomb Combfirm® HIV confirmation test (OIC-HIV). Of these, 24 samples were negative or indeterminate by WB representing a false-positive rate of the WHO two-test algorithm of 10.5% (95%CI 6.6-15.2). 17 of the 229 samples were weakly positive on rapid testing and all were negative or indeterminate by WB. The false-positive rate fell to 3.3% (95%CI 1.3–6.7) when only strong-positive rapid test results were considered. Agreement between OIC-HIV and WB was 99.1% (95%CI 96.9–99.9%) with no false OIC-HIV positives if stringent criteria for positive OIC-HIV diagnoses were used.

Conclusions

The WHO HIV two-test diagnostic algorithm produced an unacceptably high level of false-positive diagnoses in our setting, especially if results were weakly positive. The most probable causes of the false-positive results were serological cross-reactivity or non-specific immune reactivity. Our findings show that the OIC-HIV confirmation test is practical and effective in field contexts. We propose that all double-positive HIV RDT samples should undergo further testing to confirm HIV seropositivity until the accuracy of the RDT testing algorithm has been established at programme level.