INTERNSHIP AT

DEPARTMENT OF
SCIENTIFIC SERVICES, MOH

Viral Serology Laboratory

8th August – 12th November 2016

14B3130 Mazarinna Matkasim

Introduction
What is HIV?
• HIV is a virus that gradually attacks the immune system
• The virus destroys a type of white blood cell called a T-helper cell and makes copies of itself inside them
• There are many different strains of HIV – someone who is infected may carry various different strains in their
body. These are classified into types, with lots of groups and subtypes. The two main types are:
HIV-1: the most common type found worldwide
HIV-2: this is found mainly in Western Africa, with some cases in India and Europe.

What is AIDS?
• AIDS is a syndrome caused by the HIV virus. 
• It is when a person’s immune system is too weak to fight off many infections, and develops when the HIV
infection is very advanced.
• In other words, it is the end-stage condition resulting from infection with the HIV where the body can no
longer defend itself and may develop various diseases, infections and if left untreated, death.
• There is currently no cure for HIV or AIDS. However, with the right treatment and support, people can live
long and healthy lives with HIV. To do this, it is especially important to take treatment correctly and deal with
any possible side-effects.
HIV screening test
• Required by the Ministry of Health for foreign workers who are planning to work in Brunei
either on a long term contract or for a short period of time

• All the foreign employees will need to undergo repeat chest X-ray and HIV testing with the
government health authorities upon arrival to Brunei.

• Qualitative test: Detect the presence or absence of HIV antigen or antibody. An initial
positive result is followed up with additional, more sensitive tests to interpret the result

• “Screening” means testing a large group of people even though we have no reason to
believe any particular individual is infected

• Before the foreign worker is classified as positive for HIV antibody, a supplemental step
test must be taken done.
Receiving blood samples
• The blood samples are received at a reception the designated sample receiving
area.
• From all of the four districts: Brunei-Muara, Belait, Tutong and Temburong
• The receiving time, usually:
Brunei & Muara – 12 pm and 4 pm
Belait and Tutong – 2 pm
Temburong – no fixed time and only receive occasionally

• Each of the collected blood sample is placed in a plain tube with no anticoagulant
addictives. The blood samples from Brunei-Muara are arranged on a test tube racks
while the others are packed in a biohazard bag.

• Total no. of samples received is recorded in a sample record file for statistics.
 Preparation of blood samples
• The first critical step in the HIV screening, after obtaining the sample is the
preparation of the blood samples

Balance the Centrifuge the Arrange the samples Remove tube caps
samples samples onto test tube racks and check integrity

Arrange sample
Remove fibrin or clot Cross check to ensure
tubes onto sample Check fibrin or blood
with cotton swab no missing sample or
racks for analysers clot in the serum
form

Start screening test

Centrifugation of blood samples
• Centrifugation allows the red blood cells and the serum to separate through spinning at high
speed RCF of 5, 250 x g. The blood samples are spun for 10 minutes at a constant temperature of
19 degree Celsius. The blood sample tubes must be covered with caps
• Serum or plasma is yellow liquid which is used to test required for HIV screening. It has the
possibility in carrying Screening detects for both the HIV antigens or and antibodies to HIV.
• Before centrifugation, the samples are loaded onto inside adapters which are weighed using a
centrifuge balance to ensure the adapters samples are spinning equally balanced.
• 2 centrifuges are available in the lab. After done weighing, the adapters are placed inside buckets.
Each centrifuge is designed to spin 4 buckets of blood samples

serum
• After centrifugation, the samples are arranged onto test tube racks according to the running number on
sample tubes
• Preparation of blood samples is performed in a biological biosafety cabinet.
• If found any fibrin or blood clot in the serum, it must be removed using a cotton swab as to prevent
sample aspiration error on the analyser can detect its presence. This can result in the failure of the HIV
testing.
• An alarm will appear after it recognizes the fibrin or the blood clot and the test for the particular blood
sample must be repeated
• The sample integrity is also checked. If sample is grossly haemolysed, the sample is discarded needs to
be repeated.
• Cross check is done to ensure there is no missing sample or form
Modular E170 analyser
• The machine that is used for HIV screening is called Modular E170 analyser. There are 2 operational analysers
available in the lab.
• Usually, one analyser is used for the blood samples from Brunei-Muara while the other is used for screening
Belait, Tutong and Temburong blooad samples
• The analyser has a loader and an unloader at each end.
• Prepared reagent used is HIV Combi PT
• Solutions used:
 ProCell M
 CleanCell M
 PreClean M
 ProbeWash M

• Must be stored in a fridge at a temperature

range of 2-8 degree Celsius
Controls
• Controls must be tested before the HIV sreening
• It is used for quality control of the HIV Combi PT on the analyser. Thus, it monitors the accuracy
precision of the reagent immunoassays
• The controls is called are PreciControl HIV, and it is a lyophilized control serum based on human serum
(PC HIV 1 and PC HIV 2) and on buffer (PC HIV 3)
• HIV lyophilized control (in powder form) is reconstituted by mixing it with 2 ml of water
 The control solution is mixed well and leave for about 30 mins in room temperature
 At the end of 30 mins, the solution is transferred into a vial tube
Loading of blood samples
• The blood samples are loaded onto the analyser racks after the controls
completes processing and produces constant results. If the result is off
the mean line, the test for the control must be repeated
• The results of HIV screening will appear on the monitor
• The duration of obtaining the results depends on the total number of
samples loaded
 The result of HIV screening

reactive non-reactive

This is a supplementary test hence it is not the final result. The results do not determine whether it
is positive or negative for HIV
Reactive blood samples
• Reactive samples are taken out from the analyser for preparation. This is a crucial procedure. The
reactive blood sample taken from the analyser must be correct.
• The serum is transferred from the test tube into a snap cap tube using a 100 µl pipette and its sample ID
is labelled.
• It is then placed inside a Biohazard plastic together with its form
• If the sample has insufficient volume for further testing, the sample is discarded. The relevant Health
Screening Centre will be contacted to request fresh sample
• Delivery to the viral Virology laboratory at Sumbiling for further testing to confirm whether it is
positive or negative for HIV
• The results of reactive samples are recorded
• The remaining of the reactive sample is disposed into a hazardous box. It is soaked with Clorox for 24
hours.
• On the next day, the samples are ready to be autoclaved
Non-reactive blood samples
• The samples are disposed into an autoclavable biohazard waste bag and loaded into an autoclave for
sterilization. This is to kill resistant bacteria and germs microorganisms.
• Temperature: 120 degree Celsius
• After sterilization, the autoclavable biohazard waste bag is put into a biohazard incinerator carton ready
to be transported for incineration
Conclusion
• HIV Combi PT is a supplementary screening test where it can only
determine the absence or presence of either HIV antigen and/or
antibody antibodies to HIV in the serum.

• All foreign workers that are applying to work in Brunei are obligated
to test for HIV to minimize and control the spread of HIV in the
country