Knowledge and Awareness about Recent Advances in HIV Diagnostics Among General Population-A Survey

Thiru Kumaran1, Gheena S*2, Gayatri Devi R3 1Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamilnadu, India 2Department of Oral Pathology, Saveetha Dental College, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai, Tamilnadu, India 3Department of Physiology, Saveetha Dental College, Saveetha Institute of Medical and Technical Science University, Chennai, Tamilnadu, India


INTRODUCTION
HIV a retrovirus that preferentially decimates the immune system of the human being which if diagnosed in the early stage can be effectively treated with Anti Retroviral Therapy(ART) and may not progress to Acquired immunode iciency syndrome which is the last stage of the disease with reduced life expectancy (Chakraborthy et al., 2014). The virus can be transmitted through contact with infected bodily luids. AIDS can be treated but can't be cured and has the potential to be a life-long condition (Gupta and Ramani, 2016). It spreads mainly by sexual transmission and from an infected mother to her infant during pregnancy, during childbirth and through breastfeeding . Within all such biological luids, HIV can be present as infectious virus particles or virions. HIV-1 testing is primarily done using Enzyme Linked immunosorbent assay (ELISA) to detect antibodies. People who undergo ELISA with non-reactive results are considered as HIV negative, people who are reactive to ELISA are HIV-positive (Sridharan et al., 2017). Only those who are repeatedly reactive by ELISA and positive by Indirect Fluorescent Antibody test (IFA) or Polymerase Chain Reaction (PCR) or reactive by western blot are considered HIV-positive and indicative of HIV infection. Although much less commonly available, acid testing (E.g., Viral RNA or pro-viral DNA ampli ication method) can also help in diagnosis (Thangaraj et al., 2016). Modern HIV testing is extremely accurate, Single screening test is correct more than 99% of the time (Shree et al., 2019). Recommendations of the US Centers for disease control and prevention (CDC) showed that HIV testing must start with an amino acid combination test for HIV-1 and HIV-2: Antibodies and P 24 antigen. Nucleic acid test must be carried out to detect the acute infection of HIV-1 or its absence (Krishnan et al., 2018;Palati et al., 2019).
Although Indirect luorescent antibody (IFA) can be used to con irm infection in ambiguous cases, this assay is not in common usage (Thangaraj et al., 2016). Non-con irmatory western blot results should be followed up a month later by retesting. Although much less commonly available, nucleic acid testing (e.g., viral RNA or proviral DNA ampliication method) can also help diagnosis in certain situations. In case of low quantity specimen yielding inconclusive results; a second specimen is collected and tested (Hannah et al., 2018). It is important to note that although HIV is highly virulent, transmission does not occur through sex when an HIVpositive person has a consistently undetectable viral load due to ART (Shree et al., 2019). Previously it was said the chance of transmission was "very low" or "negligible" (The "Swiss Statement").
The term viral tropism refers to preferred cells which the virus usually infects (Prasanna and Gheena, 2016;Abitha and Santhanam, 2019). HIV can infect a variety of immune cells such as CD4+ T cells, macrophages, and microglial cells (Gunasekaran and R, 2016;Uma et al., 2020). HIV-1 entry to macrophages and CD4+ T cells is mediated through interaction of the virion envelope glycoproteins (gp120) with the CD4 molecule on the target cells' membrane and also with chemokine co-receptors (Sarbeen and Gheena, 2016;Harrita and Santhanam, 2019). The CCR5 co-receptor is used by almost all primary HIV-1 isolates regardless of viral genetic subtype. Indeed, macrophages play a key role in several critical aspects of HIV infection (Ahad and Gheena, 2016;Sukumaran and Padavala, 2018). The main aim of this study was to assess the knowledge and awareness about the advances in diagnostics of HIV among the general population (Manohar and Abilasha, 2019;Sheriff and Santhanam, 2018).

MATERIALS AND METHODS
The self structured questionnaire was prepared to check the knowledge and awareness of the public on recent advances in diagnostics of HIV and AIDS. The questionnaire contained 10 questions. The sample size of this survey was 100. The questionnaire was reviewed and amendments were made to improve clarity of pertinent questions and eliminate ambiguous responses. The survey instrument was a structured questionnaire with both open and close ended questions. The participants did the survey voluntarily and no incentives were given to them. The study was conducted in the month of May, 2020. The study was approved by the institutional review board. Informed consent from the participants were obtained. Only completely illed online forms were included in the study. The illed responses were veri ied by two reviewers and the collected data was entered on the same day. The entered data was analyzed using SPSS. Descriptive analysis was performed to calculated frequencies of categorical variables.

RESULTS AND DISCUSSION
In this survey, among 100 participants 48% were male and 52% were female. 37% of the participants were aware of HIV diagnostics and 63% were not aware (Figure 1). 39% of respondents believe that HIV diagnosis can be done at an early stage and 61% disagree (Figure 2). 96% opined that they were aware of several advanced diagnostic tests (Figure 3). 92% of the population believe that a Antigen Antibody test-IgG is also a diagnostic test (Figure 4). 64% responded yes that they know rapid tests like inger prick and oral swab test the antibody only whereas 37% responded negatively ( Figure 5). 61% opined that they are aware of P 24 antigen and  is in full swing and 20% were unaware (Figure 7). 84% know that rapid test tests only antibody and 16% were not aware (Figure 8). 69% know that recent testing methods have the potency to diagnose p24 antigen and 31% don't know (Figure 9). 65% believed in rapid test methods and 35% didn't believe ( Figure 10). Figure 11 represents the association between gender and awareness of HIV and its causes. It was found to be statistically not significant. Figure 12 represents the association between gender and knowledge on early diagnosis of HIV, it was found to be statistically not signi icant. Figure 13 represents the association between gender and awareness of various tests for HIV, it was found to be statistically not signi icant. Figure 14 represents the association between gender and awareness of rapid tests like inger prick and oral swab test and was found to be statistically not signi icant.
Literature search revealed that there are various diagnostic methods available for HIV diagnosis such as P24 antigen (Sridharan et al., 2017;Hannah et al., 2018), rapid test method (Shree et al., 2019), recombinant tests (Chakraborthy et al., 2014), AG test which is also known as ELISA (Uma et al., 2020;Gupta and Ramani, 2016). Even though many researches were carried on HIV diagnosis, many scientists are facing challenges to discover a curative vaccine.
In Figure 11, Pearson Chi-Square analysis-0.498, P-value-0.480, statistically not signi icant implying that there is no difference between the gender on awareness about HIV and its causes. In Figure 12, Pearson Chi-Square analysis-0.88, Pvalue was0.347, statistically not signi icant implying that there is no difference between the gender and awareness of Knowledge on early diagnosis of HIV. In Figure 13, Pearson chi-square-0.730, P-Value was 0.393, statistically not signi icant implying that there is no difference between the gender and awareness on knowledge of various tests for HIV. In Figure 14, Pearson chi-square-0.003 Pvalue was 0.959, statistically signi icant implying that there is difference between the gender and awareness of rapid tests like inger prick and Oral swab test the Antibody only.

CONCLUSION
HIV has become a chronic condition but the progression of AIDS is reduced. Treatment has been successful in many parts of the world. Based on this survey, many of the people are well aware about the recent techniques of diagnostics used in HIV. This survey will help the society by aiding in increasing awareness of the recent diagnostics of HIV, time period for diagnosis and its causes.