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The p24 antigen test is most useful in detecting antigen in supernatants from cultures that have been
inoculated with cells from a patient suspected of being infected (viral culture and isolation). The
antigen test is the method of choice for detecting the presence of free antigen in culture, and it is
two orders of magnitude more sensitive than the reverse transcriptase assay.(13) The test is most
useful for detecting viral antigen in culture fluids because large quantities of antigen are exuded
in the supernatant fluid during viral replication.

The antigen test can be performed on fluids other than those of culture and serum. Evidence
determined from the testing of cerebrospinal fluid (CSF) indicates that many patients with HIV
dementia and encephalopathy have detectable antigen in CSF, most likely due to active replication of
the virus in cerebral tissue.

The p24 antigen test can be of value in blood screening, for identification of acute infection, for
monitoring infection, andto assist in the diagnosis of infection in the newborn (each is discussed
subsequently). It has been used for detecting early infection in rape cases, identification of
infection after occupational exposure, and for assisting in the resolution of indeterminate Western
blot results. The degree to which p24 antigen assays can detect p24 antigen from all clades of HIV-1,
HIV-2, and HIV-1 Group O, however, is unknown.

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