The document discusses HIV/AIDS, including: - HIV was identified as the cause of AIDS in 1983. - HIV is transmitted through unprotected sex, contaminated blood, and from mother to child. - India's HIV epidemic began in the 1980s, with over 2 million new infections globally in 2013. - HIV diagnosis involves antibody and antigen tests, while treatment and monitoring involves CD4 counts and viral load tests.

1. Presented By : Dr Anjan Sarma
PGT, Microbiology
GMCH

2. On 5 June 1981 :
U.S. Centers for Disease Control and Prevention
(CDC ) – coined AIDS
 The rare infections presented-
Opportunistic Infections (OI),
Pneumocystis (carinii) jiroveci pneumonia and
Kaposi’s sarcoma

3.  The causative agent of AIDS was identified
two years later.
 In 1986 :
The International Committee on
Taxonomy of Viruses recommended a
separate name for the virus isolated from
AIDS patients, the Human Immunodeficiency
Virus (HIV).

5.  HIV is transmitted from one infected person to
another through :
-PENETRATIVE SEXUAL ACTS, both heterosexual
and homosexual,
-through a CONTAMINATED BLOOD TRANSFUSION
or the sharing of needles and syringes, and
-from MOTHER to CHILD.
The High-Risk groups
Sex workers (male and female),
Men having sex with men,
Trans Genders, and
Injecting drug users.

7. 2013 : 35 million infected globally
Average adult prevelance : 0.8 %
Children affected ( < 15 rs ) : 3.2 million
New Infections : 2.1 million ( overall
decline )

8.  The HIV/AIDS epidemic in India began in 1986-1987
with the detection of the first HIV infection in
Chennai and the first AIDS Case in Mumbai.
 However, nearly 25 years since the epidemic
appeared in India, the disease has not reached the
proportions predicted by experts across the world.
 2015:
21.17 lakhs HIV + people
 Children : 1.45 lakh (7% )
 New infections : 1.16 lakh in 2012
86,000 in 2015
AIDS related deaths (ARD ) declined by 54 % since
2007.
67600 deaths due to ARD

9. National Adult (15-49 yrs ) HIV
Prevalence : 0.26% (0.22-0.32)
Male : 0.30 %
Female : 0.22 %

10. STATES/UTs PREVALENCE
MANIPUR 1.15 %
MIZORAM 0.80 %
NAGALAND 0.78 %
AP & TELENGANA 0.66 %
KARNATAKA 0.45 %
GUJARAT 0.42 %
GOA 0. 40 %
MH, TR, CH, TN > 0.26 %
OR, SK, BHR, DEL, RAJ 0.21-0.25 %
OTHERS ( Including ASSAM ) < 0.20 %

11. There are two types of HIV; HIV-1 and
HIV-2. HIV-1 is further divided into three main groups;
major (M), outliers (O) and new groups (N).
HIV-1 subtype C - most predominant subtype that is
present in India, South Africa and China. Subtype B is
predominantly seen in North America and Europe

13.  Use HIV rapid diagnostic test to identify an HIV infection
Initiate treatment with ARVs
minimal diagnostics required
Monitor effectiveness of ARVs with
diagnostics (viral load, CD4) and safety
with basic laboratory tests

14.  HIV diagnosis (Antibody/Antigen testing)
 Enzyme Immunoassays (EIAs)
 Rapid tests
 Western blot (WB)
 Chemiluminescence Immunoassays (CIA),
 Immuno Floresent Assays and
 Line Immunoassays
NAAT: to detect HIV nucleic acids
DNA PCR ( upto 18 months )
bDNA assays
 Early diagnosis in infants
 P24
 Initiation and monitoring of ART
 CD4
 HIV RNALoad

15.  Blood and blood products safety. This is achieved by
mandatory testing of all donated blood units and blood
products.
 Screening of sperm, organs, and tissue donors.
 Diagnosis of HIV infection in clinically suspected cases.
 Voluntary testing after counselling.
 Epidemiological surveillance using unlinked anonymous HIV
testing.
 Research.

16.  Early detection of seroconversion.
 Early detection in infants born to HIV positive mothers.
 Effect of HIV subtypes on test performance.
 Impact of other health conditions on test performance.
 Product specific equipment.
 Technical skill

17. HIV Antibodies HIV-1 RNA HIV p24 Antigen
Most Common Test for
Established Infection
Most Common Test for
Established Infection
Rarely Used
Future use: 4th
Generation
Rarely Used
Future use: 4th
Generation
EIA
Used for Acute HIV and
Indeterminate WB
Used for Acute HIV and
Indeterminate WB

19.  Serological tests (antigen and antibody
detection):
serum/plasma/whole blood.
 DNA/RNA PCR:
Dried Blood Spots (DBS) or whole blood collected
in K2/K3 EDTA.
 CD4 enumeration tests :
Whole blood collected in K2/K3 EDTA evacuated
tubes.

20.  Ensure pre-test counselling is done and informed
consent has been obtained.
 Identify the person using at least 2 identifiers.
 Requirements for venous blood collection:
1. Sterile disposable needle and syringe with plain test
tube or bulb / plain evacuated tube (red top) with
holder and needle.
2. Tourniquet
3. Dry cotton swab
4. Spirit swab
5. Absorbent material (e.g. blotting paper)
6. Facility for appropriate waste disposal

21.  For adults, evacuated tube and 21-gauge eclipse
needle.
 For children or adults with small, fragile veins, a
butterfly needle (Sizes available: 23, 21, 19
gauge) and a 3-5 ml syringe.
 Wear gloves to comply with standard precaution.
 Proper labelling of the tubes.
 Wash hands or by disinfectant hand sanitizer.
 Avoid soiling, place absorbent.

22.  Explain procedure briefly to person.
 Collect 2-5 ml of blood.
 Do not recap the needle.
 Burn/cut the used needle in a needle destroyer.
 Immediately transfer the blood into a collection tube
gently along the tube wall without squirting.
 Discard cut needle, syringe, cotton balls, spirit swabs,
wrapper, needle cap & gloves in proper waste disposal
bags.

23.  The blood collected is allowed to CLOT for 30 mins.
 The serum should be SEPARATED as soon as possible
and should be REFRIGERATED.
 The test or evacuated tube CENTRIFUGED at : 2000
to 3000 rpm for 10 mins.
 Use MICROPIPETTE tips for testing/storage.
 NO PRESERVATIVES to be added

24. The sera can be stored at 2 to 8 C in the
refrigerator for only up to a week.
 For longer storage, specimens need to be
kept frozen at -20 C.
Repeated freeze-thawing should be avoided.

25.  Shipped as per the International Air Transport
Association’s (IATA) Regulations.
 HIV infected specimens are classified as infectious
class 6.2 substances under the United Nations’ (UN)
no. 2814
Packaging requires a 3-layer system as described ..
 No leaks or cracks.
 Plastic or screw capped
 Request slip with patient details.
 Biohazard sign
 Trained deliver person
 Prior knowledge of designated testing day

27.  Blood Collection, Storage and Transport for CD4
Enumeration:
3 ml blood in K2/K3 EDTA tube.
Transport within 48 hrs
Ambient temp., not in refrigerator.
 Blood Collection, Storage and Transport for HIV-1
DNA PCR:
To be done by personnel trained in DBS collection
technique.
 Blood Collection, Storage and Transport for HIV-1
Viral Load
K2/K3 EDTA
Plasma to be separated within 6 hrs
Stored at -20 C till further use.

28. Pre-test Counselling
# Testing without informed & explicit consent proves
to be counterproductive and has driven HIV positive
individuals underground.
# Pre-test & post-test counselling prepares the
individual to cope with the HIV test results.
Confidentiality
# Ensuring respect for the privacy and rights
# Protect them from victimization, discrimination,
and stigmatization.

29. Quantitative assay to measure HIV
antibodies
Most detect antibodies to HIV-1 and
HIV-2
Antigens coated in microwells
HIV Antigen / Antibody reaction is
detected by color change
Intensity of color reflects amount of
antibody present serum

30. Some assays can detect both HIV
antibody and HIV antigen (close
window period)
Issues:
Skilled lab technician
Large volume testing
Properly maintained equipment
required

31. First Second Third *Fourth
Uses crude viral lysateUses crude viral lysate Detects IgM and IgG in
“Sandwich” EIA
Detects IgM and IgG in
“Sandwich” EIA
Uses recombinant HIV
antigens or
peptides
Uses recombinant HIV
antigens or
peptides
Detects HIV antibodies
and p24 antigen
Detects HIV antibodies
and p24 antigen

32. GENERAT
ION
Ag / Ab CHARACTERISTICS
1st
Generation Antigens from
HIV lysates
Lack of sensitivity and specificity
2nd
Generation Recombinant
proteins and/or
synthetic
peptides
Improved sensitivity
3rd
Generation Recombinant
proteins and/or
synthetic
peptides in an
antigen
sandwich
configuration
Very high sensitivity and able to detect IgM antibody in
addition to IgG antibody; reduces the window
period considerably. Detects HIV-1 and HIV-2
simultaneously.
4th
Generation Detection of
both HIV
antigen (p24)
and both
antibodies, IgG
and IgM
Further reducing the window period

33. •Based on color change/fluorescence
•Change compared with standardized cut-
off
•Result positive or negative
•No specific antibody reaction information
•Multiple samples run with traditional EIA
•Based on color change/fluorescence
•Change compared with standardized cut-
off
•Result positive or negative
•No specific antibody reaction information
•Multiple samples run with traditional EIA
96-Well Microtiter Plate EIA Interpretation of EIAs

34. On the basis of the principle of the test, ELISA can be divided into:
Indirect
Competitive
Sandwich
Capture

35. This is the most commonly used principle.
HIV antigens are attached covalently to the solid phase support.
This allows HIV antibodies present in the specimen to bind.
These bound antibodies are subsequently detected by enzyme
labelled anti-human immunoglobulin and a specific substrate system.
If the test specimen contains anti-HIV antibodies, a colour reaction
will take place.

36. In this assay, the HIV-antibodies present in the specimen
compete with the enzyme-conjugated antibodies in the
reagent to bind to the solid phase antigen.
A competitive ELISA takes less time than indirect ELISA and
no pre-dilution of test specimen is required.

37. This is a modification to improve sensitivity and specificity
of the indirect ELISA.
The procedure for the sandwich ELISA is the same as the
indirect ELISA.
The only difference being that in this case, enzyme labelled
antigen is added in place of enzyme labelled anti-human
immunoglobulins.

38. Antigen and Antibody capture ELISAs are based on the principle of indirect or competitive
ELISAs .
A monoclonal antibody directed against an HIV antigen is bound to the solid
support. The next step is the addition of the HIV antigen supplied as a reagent. This antigen
is
captured by the monoclonal antibody bound to the solid phase. The test specimen, which has
been appropriately diluted is added next. HIV antibodies, if present in the specimen, bind to
the solid support HIV antigen. The remaining steps are the same as the steps for an indirect
ELISA.
An advantage of the antigen capture ELISA is that it is more specific than an indirect assay.
Antibody capture assays were developed to test specimens with low concentrations of HIV
antibodies (e.g., urine and saliva) or to detect a specific class of antibodies (e.g., lgG, lgM or

39.  Interpretation of ELISA Results
 Kit controls (internal controls) and previously known positive and
negative controls (external controls) should be used irrespective of the
type of ELISA used.
 Each test must be validated according to the validation criteria given in
the kit insert.
 Cut-off-value
 Each kit manufacturer has devised a method of calculation that
produces a cut off value, to classify a test specimen as positive or
negative.
 Thus, a cut-off value can be based on an average of the negative
controls, multiplied by a factor, or is based on a relationship of positive
controls to optimize sensitivity and specificity of the assay.

40.  Pre-analytical:
 Haemolysed sample
 Grossly lipaemic samples
 Repeated freezing and thawing
 Contaminated samples and reagents
 Improperly stored, expired and deteriorated reagents
 Analytical:
 Pipetting errors
 Improper incubation time and temperature
 Improper washing procedure
 Carry over from the adjacent specimen
 Equipment malfunction
 Glove -powder aerosol
 Calculation errors
 Post-analytical:
 Transcription errors

41.  Common causes of a false positive result:
 Autoimmune diseases
 Alcoholic hepatitis
 Primary biliary cirrhosis
 Leprosy
 Multiple pregnancies
 Common causes of a false negative result:
 Technical errors
 The test may be negative during the window period
and during the end stage of the disease

42.  Use recombinant and/or synthetic antigens.
 Qualitative assay to detect HIV antibodies
 Most detect HIV 1 and HIV 2
 The Principles :
 Immunoconcentration/dot blot immunoassay
(vertical flow),
 Immunochromatographic (lateral flow),
 Particle agglutination (e.g., gelatine or latex),
 Dipstick and Comb assay based on EIA.

43.  Advantages
 Do not require any special equipment
 Available in smaller test packs
 Technically simple to perform
 Sensitivity and specificity comparable to an ELISA
 Some rapid test kits can be stored at an ambient temperature (20°C to 25°C).
 Disadvantages
 Small numbers for each test run
 Quality Assurance/Quality Control at multiple sites
 Test performance varies by product
 Reader variability in interpretation of results
 Limited end-point stability of test results

44.  Serum
 Plasma
 Whole blood
 Oral fluids

45. This is a type of solid phase immunoassay where HIV antigens are
immobilized on a porous membrane.
Specimen & reagent pass through the membrane & are absorbed into
the underlying absorbent pad.
As the specimen passes through the membrane, HIV antibodies if
present, bind to the immobilized antigens.
The conjugate binds to the Fc portion of the HIV antibodies and
produces a distinct coloured dot against a white background

46. The strips/cards incorporate both the antigen and signal reagent into the
nitrocellulose strip. The specimen (usually followed by a buffer) is applied to the
absorbent pad on the kit. The specimen migrates through the strip and combines
with the signal reagent. A positive reaction results in a visual line on the
membrane where the HIV antigen has been incorporated. A procedural control is
usually incorporated into the strip
The test device is incorporated with distinct bands of purified gp120 and gp41
synthetic peptides, specific to HIV-1 at test region '1' and gp36 synthetic peptide
specific to HIV-2 at test region '2.'

48. Lattice formation in particle agglutination
assay
Agglutination assays are used for antibody detection, where the antigen is coated on a
carrier particle and the antigen antibody reaction is observed in clumps.
Reactive: If a test specimen contains HIVantibodies, a lattice network will form between
the antigen carrying particles and HIV specific antibodies. It will appear as the formation of
clumps.
Non-reactive: Absence of the agglutination denotes non-reactive result.

49. This is a rapid assay intended to differentiate
between HIV-1 and HIV-2 antibodies in
human serum or plasma. The comb test
consists of a comb like device with
projections. Each tooth represents the solid
phase and has three spots for adsorption of a
specific antigen/antibody. HIV-1 and HIV-2
antigens are immobilized as circular spots at
two sites. The third spot acts as an antibody
control containing goat anti-human IgG.
Interpretation of Results:
Invalid test: Absence of upper
spot
Non-Reactive: Appearance of
upper spot only
HIV-1 Reactive: Appearance of
upper and middle spot
HIV-2 Reactive: Appearance of
upper and lower
spot
HIV-1 and HIV-2 Reactive:
Appearance of all
three spots

50. ICTC Room No. 10
COMBS Test
Kit : Comb Aids – RS
HIV 1 + 2 Immunodot test kit
Manufacturer : ARKRAY
Healthcare Pvt. Ltd.

52. SD BIO-LINE HIV ½ 3.0
Manfactured by :
Alere Medical Pvt. Ltd

53. SD BIOLINE : An immunochromatographic assay for
the differential and qualitative detection of all
isotypes(IgG, IgM, IgA) antibodies specific to HIV-1
including subtype O and HIV-2 simultaneously, in
human serum, plasma or whole blood.

54. AIDSCAN
A Rapid Trispot Test Kit to
detect Antibodies to HIV 1 &
2 in Human Serum or
Plasma

55. Used as supplemental test for confirmation
(only difficult cases)
Detects antibodies to specific HIV antigens
on cellulose strip
Issues:
 Multiple standards for performance and
interpretation .
 Expensive
 Limited commercial availability.

56.  In the western blot, the various HIV specific recombinant or
synthetic antigens are adsorbed on to nitrocellulose paper.
 The antibody, when present, attaches to the antigen on the strip
and the antigen antibody complex is then detected using enzyme
conjugate and substrate.
 This is similar to what is done in an ELISA test, except that the
product is insoluble.
 WB tests detect the presence of antibodies against specific HIV
proteins, which are seen as bands on the test strip.
 WB tests are a highly specific conformational test. NACO is
presently providing it at the National Reference Laboratory
level for resolving indeterminate results.

57. p = proteinp = protein
gp = glycoproteingp = glycoprotein
Number = molecular weightNumber = molecular weight

58. Human HIV Antibodies
(from patient serum)
Y YY Y
HIV Western blot Strip
YY
HIV Antigens
(on Western blot)
YY Y
Antihuman IgG Antibodies
Enzyme Detector
Color Reagent

63.  Sensitivity
Probability that test is positive if person is
infected

64. Perons infected with HIV : n=50 HIV antibody testing: 49/50 positive
Sensitivity = 49/50 = 98%

65. HIV Antibody Tests
Sensitivity >> 99%

66. HIV Antibody Tests
Sensitivity > 99 %

67. HIV Antibody TestingHIV-Infected Persons
False Negative

68. • Acute HIV Infection
• Advanced HIV Infection
• Antiretroviral Therapy

69.  Specificity
Probability that test is negative if person is
not infected

70. Persons NOT Infected with HIV:
n=50
Specificity = 48/50 = 96%
 HIV Antibody Testing: 48/50
Negative

71. HIV AAntibody testing HIVTestingPersons not infected with HIV with HIV
False Positive

72. • Other Viral Diseases
• Hematologic Disorders
• Liver Disease
• Immunizations
• Autoimmune Disorders

73.  Quantitative molecular assay measures amount
of HIV in blood products
 Used to:
 Predict disease progression
 Assist with deciding when to initiate anti-retroviral
therapy
 Monitors response to anti-retrovirals
 Issues:
 Expensive
 Labor-intensive
 Special facilities

74.  Serological assays for the detection of HIV antibodies
 Situations where diagnosis of HIV infections is established using molecular assays to
detect viral genomes :
1) patients in the window period and
2) infants born to HIV positive mothers.
Diagnosis of Paediatric HIV Infection (< 18 months)
 The standard diagnostic method for HIV infection in adults (i.e., testing for
antibodies) has limited utility in newborns, infants, and children less than 18 months
of age. This is due to the transplacental transfer of maternal IgG (including HIV-
specific antibodies) from infected mothers to their babies during pregnancy.
 Maternal antibodies may persist in an infant’s blood until 18 months after birth, and
are difficult to differentiate from those produced by an infected infant. Therefore,
antibody tests cannot produce a definitive diagnosis of HIV infection until 18 months
of age.
 Nucleic Acid Testing (NAT) can facilitate early infant diagnosis. NACO recommends

75. Detection of Acute HIV Infection
 Positive NAT results confirm the HIV diagnosis, the
NAT result may turn out negative if tested within 7
to 10 days of exposure
 At present, NACO does not recommend the use of
NAT for the diagnosis of acute HIV infection.
 NATs include tests for the qualitative detection of
HIV-1 DNA or RNA, as well as the quantitative
detection of HIV-1 RNA (viral load determination)
through various assays.

76.  Sensitivity of a traditional PCR test for Infants (4-6
weeks ) : 90-100 %
 AMPLICOR HIV-1 DNA PCR Test
 Commercially available test, approved by the Drug
Controller General of India(DCGI),
 used to test dried blood spots or whole blood collected in
EDTA
 99.3 % sensitivity and 96 % specificity.
 HIV-1 DNA PCR test :
NACO’s first choice for the diagnosis of HIV-1 infection
in infants and children less than 18 months of age

78.  Quantitative HIV-1 RNA assays detect plasma (cell-free) viral RNA by using
various techniques.
 Methods of amplification of HIV-1 RNA :
1 ) Target amplification by
a. Reverse transcriptase PCR (RT-PCR)
b. Real time PCR (qPCR)
c. Nucleic acid sequence-based amplification (NASBA)
2) Signal amplification by branched-chain DNA technique (bDNA)
Disadvantages :
1) More expensive than qualitative PCR for HIV 1.
1) Lack of consensus on the cut-off for labelling a sample as positive
(recommended cut-off is >10,000 copies/mL)

79.  Core protein of the virus
 Positive p24 test confirms diagnosis of HIV infection;
however, a negative test does not rule out HIV
infection.
 EIA detects p24 antigen before antibody can be
detected
 Detected 2 to 3 weeks after HIV infection
 Detected about 6 days before antibody tests become
reactive
 Used for :
 Diagnosis of pediatric HIV-1 infections
 Blood bank safety (high incidence countries)
 Issues:
 Level 4 complexity

80. CD4 T-lymphocyte counts used for:
 Determining clinical prognosis
 Assessing criteria for antiretroviral
therapy
 Monitoring therapy
Manual and automated methods
Issues:
 Requires high level of technical skill for
test performance and interpretation
 Properly maintained equipment

81.  In general, the following testing policies need
consideration:
 Testing should be part of the overall
comprehensive prevention programme.
 Testing should be technically sound and
appropriate.
 Testing procedures must be field appropriate.
 Testing procedures must be cost effective.
 Laboratory procedures must be monitored to
ensure quality.

82.  Particular testing situation for implementing
strategy :
 Blood /Organ donation safety
 Surveillance
 Diagnosis
 HIV testing strategies involve a logical sequence of
performing two or more tests, one after the other
(serial) or simultaneously (parallel) to arrive at a
conclusion on the HIV status of a person being tested.
 A testing algorithm refers to the combination and
sequence of specific tests that are used to fulfil the
testing strategy

83.  Following parameters should be considered before
testing:
 Sensitivity of the test kit
 Specificity of the test kit
 Prevalence of HIV infection in the population
 Cost effectiveness
 Appropriateness of testing to national guideline
strategies and to the infrastructure facilities available.

84.  Strategies mainly implemented
 1.ELISA/ Rapid tests (E/R) used in strategy I, II, & Ill
 2. Confirmatory tests with high specificity, like WBs
and line immunoassays, are used in problem cases,
e.g., in cases of indeterminate/discordant result of
E/R.
 NACO recommends the use of ELISA kits with a
sensitivity of ≥99.5 % and the specificity of ≥98 %
and rapid kits with a sensitivity of ≥99.5 % and the
specificity of ≥98% .

89.  For monitoring the stage and progression of HIV infection can
be classified into:
 Immunologic tests
 CD4 T cell enumeration
 Virological assays
 HIV RNA load assays
 Other Assays - Measurement of HIV p24, Reverse Transcriptase
(RT) activity assay
 NACO ART centres use CD4 T cell enumeration as the routine
method to monitor HIV infected individuals, to initiate ART, and
for follow-up.
 Immunological tests for CD4 T cell enumeration
A CD4+ T cell count < 350 cells/ul is considered to start ART.

90.  Target amplification assays
 Quantitative reverse transcriptase PCR (RT-PCR)
Amplicor HIV-1 Monitor Test, version 1.5 (Standard/ Ultrasensitive/ COBAS)
(Roche)
 Real time PCR (qPCR)
COBAS TaqMan HIV-1 Test (Roche)
RealTime HIV-1 Amplification (Abbott)
VERSANT HIV kPCR v1.0 (Siemens)
 Nucleic acid sequence based amplification assays (NASBA)
NucliSENS HIV-1 QT assay (bioMerieux)
 NASBA with real time detection
NucliSENS EasyQ HIV-1 v2.0 (bioMerieux)
 Signal amplification
Branched DNA (bDNA) assay
VERSANT HIV-1 RNA3.0 assay (Siemens)

92.  The following are some of the responsibilities of the
laboratory staff:
 Daily assignment of work to technician (by laboratory
in-charge)
 Monitoring of the laboratory environment, including
temperature log and cleaning log
 Ensuring proper biosafety including PPE
 Stock verification (physical) - at the beginning and the
end of each day
 Preparation of fresh 0.1 percent and 1 percent sodium
hypochlorite solution every morning.

93.  Factors that influence Risk of Infection
Type of needle (hollow bore vs. solid)
Device visibly contaminated with patient’s
blood
Depth of injury
The amount of blood involved in the exposure
The amount of virus (viral load) in the exposed
blood/body fluid at the time of exposure
Timely (<2 hours and up to 72 hours)
availability and efficacy of the PEP.

94.  Blood, blood products, all body fluids, and materials contaminated with them are
considered as infectious.
 Use appropriate barrier precautions to prevent exposure to skin and mucous
membranes.
 Take special care of handling sharp objects.
 Thoroughly wash hands with water and soap.
 Work surfaces should be decontaminated with 0.1 percent sodium hypochlorite
solution.
 Laboratory personnel should refrain from mouth pipetting, eating, drinking, or
smoking in the work area.
 Access to the laboratory should be limited to trained personnel only.
 Food and drink must be stored in refrigerators in areas other than the work area.
 All HCPs must be immunized against HBV

95.  Don’ts
 Do not panic
 Do not place the pricked finger into the mouth reflexively
 Do not squeeze blood from wound
 Do not use bleach, alcohol, iodine, antiseptic, detergent, etc.
Do’s
 Stay calm
 Remove gloves, if appropriate
 Wash exposed site thoroughly with running water and soap.
Irrigate thoroughly with water, if splashes have gone into the eyes
or mouth
 Consult the designated physician/personnel immediately as per
institutional guidelines, for
 management of the occupational exposure

96.  Steps to be followed after accidental exposure
to blood/other potentially infectious materials:
 1. First aid
 2. Risk assessment
 3. Informed consent and counselling
 4. Decision on prophylactic treatment for HIV and
HBV
 5. Monitoring and follow up of HIV, HBV, and HCV
status
 6. Documentation and recording of exposure

101.  Preparation and Regular Review of SOPs
 To prepare panel sera for the proficiency testing of SRLs and ICTCs
 Collection of Kits from SACS/ NACO Designated Storage Centres
 A well-defined inventory management system designed to ensure
an uninterrupted reagent & kits supply.
 Calibration and Preventive Maintenance of Equipment
 Participation in the EQA Programme, Root-cause analysis, and
Corrective Action for Erroneous Results
 Participation in Workshops (ICTC)/Organization of Workshops (SRL)

102.  Collection of DBS for HIV Diagnosis in Infants and Children <18 Months
 Participation in Sentinel Surveillance Cycles
 Management and Recording of Adverse Incidents
 Indeterminate and discordant samples must be sent by ICTCs to SRLs. The
SRL should confirm these from the NRL and give necessary feedback to the
client and ICTCs respectively
 Complaints regarding kit quality must be communicated to SACS and a copy
should be sent to NACO.
 All the patients referred from the STI/RTI centre are to be screened for
syphilis along with HIV testing.
 Audit and Review

103.  1 All India Institute of Medical Sciences (AIIMS), Delhi
 2 Christian Medical College (CMC), Vellore, Tamil Nadu
 3 Institute of Preventive Medicine (IPM), Hyderabad, Andhra Pradesh
 4 Madras Medical College (MMC), Chennai, Tamil Nadu
 5 National AIDS Research Institute (NARI), Pune, Maharashtra
 6 National Centre for Disease Control (NCDC), Delhi
 7 National Institute of Biologicals (NIB), Noida, Uttar Pradesh
 8 National Institute of Cholera and Enteric Diseases (NICED), Kolkata, West
Bengal
 9 National Institute of Immunohaematology (NIIH), Mumbai, Maharashtra
 10 National Institute of Mental Health and Neuro Sciences (NIMHANS),
Bengaluru,Karnataka
 11 Regional Institute of Medical Sciences (RIMS), Imphal, Manipur
 12 School of Tropical Medicine (STM), Kolkata, West Bengal
 13 Tamil Nadu Dr M G Ramachandran (TN Dr MGR ) University, Tamil Nadu

104. Sr.No. Referral States / UTs Name of laboratory & Address
1 Maharashtra, Mumbai, Dadra
& Nagar Haveli, Daman & Diu,
Goa
NACO Program Laboratory
National AIDS Research Institute
Plot No.73, “G “Block, MIDC, Bhosari, Pune-411026
Ph. No: 020-27331200 Ext.
E mail: nrl.nari1@gmail.com
2 Delhi, Haryana, Himachal
Pradesh,Jammu & Kashmir,
Punjab,Chandigarh, Rajasthan
Centre of AIDS & Related Diseases,
National Centre for Disease Control,
22- Shamnath Marg, New Delhi-110054.
Tele /Fax: 011- 23934517
Email: nrl.nicd@gmail.com
3 Andhra Pradesh Institute of Preventive Medicine,
BSQC Department, Narayanguda, Near YMCA
Hyderabad-500029
Ph. No: 040-27568167
Email: nrl.ipm@gmail.com
4 Assam, Meghalaya,
Arunachal Pradesh
Dept. of Microbiology,
Gauhati Medical College & Hospital,
Guwahati – 781032
Ph. No: 0361-2529457
Email: srl.assam.gmc@gmail.com