Wyoming Department of Health

Preventive Health and Safety Division

Public Health Laboratory

IMMUNOLOGY LABORATORY-HEPATITIS AND HIV TESTING

SEXUALLY TRANSMITTED INFECTIONS LABORATORY

Microbiologist Claudia Rogers, BS MT (ASCP) (307) 777-6061

Microbiologist Beth White, BS (307) 777-6063

Hepatitis, HIV, and Syphilis testing is available as descibed below.

HIV Antibody Testing Syphilis Hepatitis Markers

HIV Antibody Testing

TYPE OF TEST	EIA for the presence of HIV-1 (M & O groups) and HIV-2 antibodies.
SPECIMEN REQUIREMENTS	Submit 7 ml of whole blood in red top or tiger top tube or 2 ml of serum.
SHIPPING REQUIREMENTS	If using WPHL mailing containers, place specimen in the biohazard bag with absorbent paper and put into the aluminum container. Wrap the completed WPHL test request form around the outside of the aluminum container and insert this into the cardboard mailing container. If not using the WPHL mailing containers, place the specimen in the biohazard bag with absorbent paper and insert the completed WPHL test request form into the outside pocket of the bag. Then place into an approved shipping container. Ship as diagnostic specimen following postal or carrier shipping regulations.
DAYS TEST PERFORMED	Tuesday and Thursday.
RESULTS AVAILABLE	Results are mailed upon completion. REACTIVE EIA results are repeated in duplicate, and if REACTIVE again, are then reflexed to MULTISPOT. REACTIVE results are called to the submitter.
REPORTING & INTERPRETATION	HIV results are reported as NONREACTIVE, REACTIVE, INDETERMINATE or INCONCLUSIVE. NONREACTIVE results indicate no detectable antibodies for HIV-1 and HIV-2. However, nonreactive results do not preclude the possibility of exposure to HIV or early infection. REACTIVE EIAs are repeated in duplicate. If the specimen is repeatedly reactive, the specimen is reflexed to MULTISPOT, a supplemental test which detects and differentiates HIV-1 and HIV-2 antibodies. This replaces the confirmatory Western Blot.
ADDITIONAL COMMENTS	MULTISPOT is a qualitative immunoassay which detects and differentiates HIV-1 and HIV-2 antibodies. REACTIVE indicates the presence of HIV-1 and/or HIV-2 antibodies. A REACTIVE MULTISPOT detecting HIV-2 antibodies will be differentiated with a specific note indicating REACTIVE, HIV-2 antibodies present. INDETERMINATE is reported when the HIV EIA is repeatedly reactive followed by an indecisive HIV-1 MULTISPOT. Further testing for HIV RNA is recommended. INCONCLUSIVE is reported when the HIV EIA is repeatedly reactive followed by a nonreactive MULTISPOT. Further testing for HIV RNA is recommended, to identify a possible early or acute HIV infection.

Syphilis

TYPE OF TEST

ASI RPR Card Test for Syphilis. Flocculation test for the detection of reagin antibodies associated with Syphilis.

SPECIMEN REQUIREMENTS

Heated or unheated serum samples, plasma containing EDTA, CPD, CPDA-1, heparin or sodium citrate as anticoagulants are all acceptable sample types. Plasma specimens should be from tubes or blood units which have been collected with adequate volume to provide the appropriate proportions of specimen to anticoagulant.

A minimum of 2.0ml or serum or 7.0ml of whole blood is requested.

This test should not be used for testing spinal fluids.

SHIPPING REQUIREMENTS
If using WPHL mailing containers, place specimen in the biohazard bag with absorbent paper and put into the aluminum container. Wrap the completed WPHL test request form around the outside of the aluminum container and insert this into the cardboard mailing container.
If not using the WPHL mailing containers, place the specimen in the biohazard bag with absorbent paper and insert the completed WPHL test request form into the outside pocket of the bag. Then place into an approved shipping container.

Ship as diagnostic specimen following postal or carrier shipping regulations.

DAYS TEST PERFORMED

Tuesdays and Fridays

RESULTS AVAILABLE

Upon completion.

REPORTING & INTERPRETATION

Results will be reported as REACTIVE (Antibodies are present) and NONREACTIVE (Antibodies are absence). Samples that are found to be REACTIVE will also contain TITER results.

ADDITIONAL COMMENTS

Reactive specimens are sent to Quest Diagnostics for confirmatory testing. Reactive RPR results are held until FTA is completed.

Overly hemolyzed specimens will be rejected.

Hepatitis Markers

TYPE OF TEST

EIA for the presence of Hepatitis markers.

SPECIMEN REQUIREMENTS

Submit 7 ml of whole blood in red top or tiger top tube or 2 ml of serum.

SHIPPING REQUIREMENTS

If using WPHL mailing containers, place specimen in the biohazard bag with absorbent paper and put into the aluminum container. Wrap the completed WPHL test request form around the outside of the aluminum container and insert this into the cardboard mailing container.

If not using the WPHL mailing containers, place the specimen in the biohazard bag with absorbent paper and insert the completed WPHL test request form into the outside pocket of the bag. Then place into an approved shipping container.

Ship as diagnostic specimen following postal or carrier shipping regulations.

DAYS TEST PERFORMED

Tuesday and Thursday.

RESULTS AVAILABLE

Results will be mailed upon completion. REACTIVE Hepatitis B surface antigen and Core IgM, Hepatitis C, and Hepatitis A IgM results are repeated and called to the submitter.

REPORTING & INTERPRETATION

Hepatitis B - Three tests are available to determine the Hepatitis B status: HBsAb - Hepatitis B surface antibody; HBsAg - Hepatitis B surface antigen; and HBc-IgM - Hepatitis B core IgM antibody.

HBsAb - Hepatitis B surface antibody This test should be requested to detect Hepatitis B antibody. Results are reported as REACTIVE, NON-REACTIVE or BORDERLINE. REACTIVE indicates the presence of antibody as a result of a previous Hepatitis B infection or vaccination series and the patient is considered immune. BORDERLINE indicates borderline status and interpretation should be based on other clinical information or subsequent testing. NONREACTIVE indicates non-detectable or absent levels of antibody. If the patient is known to have been vaccinated against Hepatitis B, their antibody levels may be present but non-detectable. Results are qualitative and are not reported as quantitative titers.

HBsAg - Hepatitis B surface antigen This test should be requested to detect surface antigen and determine if the patient has an acute or chronic Hepatitis B infection and/or is potentially infectious. Results are reported as REACTIVE or NON-REACTIVE. REACTIVE indicates the presence of Hepatitis B surface antigen from an acute or chronic infection. NONREACTIVE indicates the absence of surface antigen. This marker should be ordered in conjunction with HBc-lgM to differentiate the infection status.

HBc-lgM - Hepatitis B Core IgM This test should be requested to detect Core IgM antibody and determine if the patient has an acute Hepatitis B infection and/or is potentially infectious. Results are reported as REACTIVE or NON-REACTIVE. REACTIVE indicates the presence of Core IgM antibody from an acute infection and the patient should be considered infectious. NONREACTIVE indicates the absence of Core IgM antibody. This marker should be ordered in conjunction with HBsAg to help determine infection status.

Hepatitis C – HCV This test should be requested to detect Hepatitis C antibody. Results are reported as REACTIVE or NONREACTIVE. REACTIVE indicates the presence of antibody as a result of Hepatitis C infection. However, this screening test will not differentiate between acute, chronic, or resolved/past infections. Patient may or may not be infectious if the screening test is positive. NONREACTIVE indicates no detectable antibodies present.

REACTIVE results are reported based on the CDC recommended algorithm in which high repeat reactive HCV (EIA) values, greater than 3.8 signal to cutoff ratio, may be considered screening test positive. The guidelines report that 95 percent of these cases are RIBA positive on confirmation. An interpretation of this recommendation will be included with the test results.

If the signal to cutoff ratio is less than 3.8 on the screening EIA, an interpretation will be included with the test results recommending further, more specific testing to rule out a false positive.

Hepatitis A Two tests are available to determine the status of a Hepatitis A infection: Total antibody - HAV-Total and IgM antibody - HAV-IgM. Both tests should be ordered together. This testing is only offered in the event of an outbreak.

HAV-Total antibody This test detects both IgG and IgM antibodies. Results are reported as REACTIVE or NON-REACTIVE. REACTIVE indicates the presence of Total antibody as a result of a previous Hepatitis A infection or vaccination and the patient is considered immune. NONREACTIVE indicates no detectable antibodies present. It is not offered to determine routine patient immune status resulting from vaccination.

HAV-IgM antibody This test detects Hepatitis A IgM antibodies present during acute infections and should be requested to determine if the patient is actively infected and/or potentially infectious. Results are reported as REACTIVE or NONREACTIVE. REACTIVE indicates the presence of IgM antibody from an acute infection and the patient should be considered infectious. NONREACTIVE indicates the absence of Hepatitis A IgM antibody.

ADDITIONAL COMMENTS

Return to Microbiology

TYPE OF TEST	ASI RPR Card Test for Syphilis. Flocculation test for the detection of reagin antibodies associated with Syphilis.
SPECIMEN REQUIREMENTS	Heated or unheated serum samples, plasma containing EDTA, CPD, CPDA-1, heparin or sodium citrate as anticoagulants are all acceptable sample types. Plasma specimens should be from tubes or blood units which have been collected with adequate volume to provide the appropriate proportions of specimen to anticoagulant. A minimum of 2.0ml or serum or 7.0ml of whole blood is requested. This test should not be used for testing spinal fluids.
SHIPPING REQUIREMENTS	If using WPHL mailing containers, place specimen in the biohazard bag with absorbent paper and put into the aluminum container. Wrap the completed WPHL test request form around the outside of the aluminum container and insert this into the cardboard mailing container. If not using the WPHL mailing containers, place the specimen in the biohazard bag with absorbent paper and insert the completed WPHL test request form into the outside pocket of the bag. Then place into an approved shipping container. Ship as diagnostic specimen following postal or carrier shipping regulations.
DAYS TEST PERFORMED	Tuesdays and Fridays
RESULTS AVAILABLE	Upon completion.
REPORTING & INTERPRETATION	Results will be reported as REACTIVE (Antibodies are present) and NONREACTIVE (Antibodies are absence). Samples that are found to be REACTIVE will also contain TITER results.
ADDITIONAL COMMENTS	Reactive specimens are sent to Quest Diagnostics for confirmatory testing. Reactive RPR results are held until FTA is completed. Overly hemolyzed specimens will be rejected.

TYPE OF TEST	EIA for the presence of Hepatitis markers.
SPECIMEN REQUIREMENTS	Submit 7 ml of whole blood in red top or tiger top tube or 2 ml of serum.
SHIPPING REQUIREMENTS	If using WPHL mailing containers, place specimen in the biohazard bag with absorbent paper and put into the aluminum container. Wrap the completed WPHL test request form around the outside of the aluminum container and insert this into the cardboard mailing container. If not using the WPHL mailing containers, place the specimen in the biohazard bag with absorbent paper and insert the completed WPHL test request form into the outside pocket of the bag. Then place into an approved shipping container. Ship as diagnostic specimen following postal or carrier shipping regulations.
DAYS TEST PERFORMED	Tuesday and Thursday.
RESULTS AVAILABLE	Results will be mailed upon completion. REACTIVE Hepatitis B surface antigen and Core IgM, Hepatitis C, and Hepatitis A IgM results are repeated and called to the submitter.
REPORTING & INTERPRETATION	Hepatitis B - Three tests are available to determine the Hepatitis B status: HBsAb - Hepatitis B surface antibody; HBsAg - Hepatitis B surface antigen; and HBc-IgM - Hepatitis B core IgM antibody. HBsAb - Hepatitis B surface antibody This test should be requested to detect Hepatitis B antibody. Results are reported as REACTIVE, NON-REACTIVE or BORDERLINE. REACTIVE indicates the presence of antibody as a result of a previous Hepatitis B infection or vaccination series and the patient is considered immune. BORDERLINE indicates borderline status and interpretation should be based on other clinical information or subsequent testing. NONREACTIVE indicates non-detectable or absent levels of antibody. If the patient is known to have been vaccinated against Hepatitis B, their antibody levels may be present but non-detectable. Results are qualitative and are not reported as quantitative titers. HBsAg - Hepatitis B surface antigen This test should be requested to detect surface antigen and determine if the patient has an acute or chronic Hepatitis B infection and/or is potentially infectious. Results are reported as REACTIVE or NON-REACTIVE. REACTIVE indicates the presence of Hepatitis B surface antigen from an acute or chronic infection. NONREACTIVE indicates the absence of surface antigen. This marker should be ordered in conjunction with HBc-lgM to differentiate the infection status. HBc-lgM - Hepatitis B Core IgM This test should be requested to detect Core IgM antibody and determine if the patient has an acute Hepatitis B infection and/or is potentially infectious. Results are reported as REACTIVE or NON-REACTIVE. REACTIVE indicates the presence of Core IgM antibody from an acute infection and the patient should be considered infectious. NONREACTIVE indicates the absence of Core IgM antibody. This marker should be ordered in conjunction with HBsAg to help determine infection status. Hepatitis C – HCV This test should be requested to detect Hepatitis C antibody. Results are reported as REACTIVE or NONREACTIVE. REACTIVE indicates the presence of antibody as a result of Hepatitis C infection. However, this screening test will not differentiate between acute, chronic, or resolved/past infections. Patient may or may not be infectious if the screening test is positive. NONREACTIVE indicates no detectable antibodies present. REACTIVE results are reported based on the CDC recommended algorithm in which high repeat reactive HCV (EIA) values, greater than 3.8 signal to cutoff ratio, may be considered screening test positive. The guidelines report that 95 percent of these cases are RIBA positive on confirmation. An interpretation of this recommendation will be included with the test results. If the signal to cutoff ratio is less than 3.8 on the screening EIA, an interpretation will be included with the test results recommending further, more specific testing to rule out a false positive. Hepatitis A Two tests are available to determine the status of a Hepatitis A infection: Total antibody - HAV-Total and IgM antibody - HAV-IgM. Both tests should be ordered together. This testing is only offered in the event of an outbreak. HAV-Total antibody This test detects both IgG and IgM antibodies. Results are reported as REACTIVE or NON-REACTIVE. REACTIVE indicates the presence of Total antibody as a result of a previous Hepatitis A infection or vaccination and the patient is considered immune. NONREACTIVE indicates no detectable antibodies present. It is not offered to determine routine patient immune status resulting from vaccination. HAV-IgM antibody This test detects Hepatitis A IgM antibodies present during acute infections and should be requested to determine if the patient is actively infected and/or potentially infectious. Results are reported as REACTIVE or NONREACTIVE. REACTIVE indicates the presence of IgM antibody from an acute infection and the patient should be considered infectious. NONREACTIVE indicates the absence of Hepatitis A IgM antibody.
ADDITIONAL COMMENTS