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Human Immunodeficiency Virus (HIV) Test

Demak L. Tobing

A human immunodeficiency virus (HIV) test detects antibodies to HIV or the genetic material (DNA or RNA) of HIV in the blood or another type of sample. This determines whether an HIV infection is present (HIV-positive). HIV infects white blood cells called CD4+ cells, which are part of the bodys immune system that help fight infections. HIV can progress to acquired immunodeficiency syndrome (AIDS).

After the original infection, it takes between 2 weeks and 6 months for antibodies to HIV to appear in the blood. The period between becoming infected with HIV and the point at which antibodies to HIV can be detected in the blood is called the seroconversion or "window" period. During this period, an HIV-infected person can still spread the disease, even though a test will not detect any antibodies in his or her blood.

Several tests can find antibodies or genetic material (RNA) to the HIV virus. These tests include:
Enzyme-linked immunosorbent assay (ELISA). This test is usually the first one used to detect infection with HIV.

If antibodies to HIV are present (positive), the test is usually repeated to confirm the diagnosis.
If ELISA is negative, other tests are not usually needed. This test has a low chance of having a false result after the first few weeks that a person is infected.

Western blot.
This test is more difficult than the ELISA to perform, but it is done to confirm the results of two positive ELISA tests.

Polymerase chain reaction (PCR). This test finds either the RNA of the HIV virus or the HIV DNA in white blood cells infected with the virus. PCR testing is not done as frequently as antibody testing, because it requires technical skill and expensive equipment.

This test may be done in the days or weeks after exposure to the virus. Genetic material may be found even if other tests are negative for the virus. The PCR test is very useful to find a very recent infection, determine if an HIV infection is present when antibody test results were uncertain, and screen blood or organs for HIV before donation.

Testing is often done at 6 weeks, 3 months, and 6 months after exposure to find out if a person is infected with HIV.

Why It Is Done
A test for the human immunodeficiency virus (HIV) is done to: Detect an HIV infection. Testing is often done for people with risk factors for HIV infection and people who have symptoms of an HIV infection. Screen blood, blood products, and organ donors to prevent the spread of HIV.

Screen pregnant women for HIV infection. The United States Preventive Services Task Force recommends all pregnant women be screened. Pregnant women who are infected with HIV and receive treatment are less likely to pass the infection on to their babies than are women who do not receive treatment.

Find out if a baby born to an HIV-positive woman also is infected with HIV. PCR is often done in this case because the baby may get antibodies against HIV from the mother and yet not be infected.

The Centers for Disease Control and Prevention (CDC) recommend HIV screening as part of routine blood testing. You and your doctor can decide if testing is right for you. This test is not done to determine if a person has AIDS. A diagnosis of AIDS means a person is HIVpositive and other problems are present.

How To Prepare
You do not need to do anything before you have this test. A test for HIV infection can't be done without your consent. Most doctors offer counseling before and after the test to discuss:
How the test is done, what the results mean, and any other tests that may be done. How the diagnosis of an HIV infection may affect your social, emotional, professional, and financial outlooks. The benefits of early diagnosis and treatment.

Before the test, it is important to tell your doctor how and where to contact you when your test results are ready. If your doctor has not contacted you within 1 to 2 weeks of your test, call and ask for your results.

Results
A human immunodeficiency virus (HIV) test detects antibodies to HIV or the genetic material (DNA or RNA) of HIV in blood or another type of sample. This determines whether an HIV infection is present (HIV-positive). ELISA results are usually available in 2 to 4 days. Results of the other tests, such as the Western blot or IFA, take 1 to 2 weeks.

What Affects the Test


Reasons you may not be able to have the test or why the results may not be helpful include: Using corticosteroids.

Antibody testing during the seroconversion period.


Having an autoimmune disease, leukemia, or syphilis. Drinking too much alcohol.

What To Think About


After initial testing, it is important for your doctor to contact you with the results of your test. Be sure to tell your doctor how and where to contact you. If your doctor has not contacted you within 1 to 2 weeks of your test, call and ask for your results.

The ELISA is a good screening test, because it is usually positive when an HIV infection is present. But the ELISA test results can indicate HIV is present when it is not (false-positive). So the ELISA alone cannot be used to make a definite diagnosis of HIV infection. No one is considered HIV-positive until he or she has a positive Western blot, IFA, or PCR test.

Detecting HIV in a newborn infant is difficult. Until about 18 months of age, even a baby who is not infected may still have HIV antibodies received from his or her HIV-positive mother. A PCR test may be done to see if HIV genetic material (RNA or DNA) is present in the baby.

To be certain that an HIV infection is not present, a person must test negative for the virus at least 6 months after the last possible exposure to HIV. Testing is often done at 6 weeks, 3 months, and 6 months to find out whether a person is infected.

Home blood test kits to detect an HIV infection are available without a prescription at pharmacies or through mail order.
These kits provide instructions and materials for collecting a blood sample that is then sent to a lab for analysis. Results are available over the phone using an anonymous code number. Counseling is also available over the phone for people who use the test kit.

Rapid test kits are also available and results are received within a half-hour, compared to 1 to 2 weeks with conventional testing. Positive rapid HIV test results need to be confirmed by a Western blot test.

A screening test for HIV infection may also be done on urine or saliva. An oral HIV test finds antibodies to HIV. Urine testing is rarely done. Oral test kits that find HIV-1 and HIV-2 in saliva have been approved by the United States Food and Drug Administration (FDA). The test results are provided the same day. Test results that show an HIV infection need to be confirmed by a Western blot test.

Most states require health professionals, clinics, and hospitals to report confirmed cases of HIV infection to the state health department.
Some states allow anonymous reporting (the person's name or other identifying information is not provided). Other states require confidential reporting (identifying information is provided but only to authorized public health officials). All states must report the numbers of cases of AIDS, without names or other identifying information, to the Centers for Disease Control and Prevention (CDC).

If you have a positive test result, contact your sex partners to inform them. They may want to be tested. You may be able to get help from your local health department to do this. After an HIV infection is present, other tests are done to determine when to treat the infection and how treatment is working. These tests include a CD4+ count and the viral load. For more information, see the topics CD4+ Count and Viral Load Measurement.

Two types of HIV have been identified. HIV-1 causes almost all of the cases of AIDS worldwide.
HIV-2 is found mostly in West Africa.

Projected Manpower & Equipment Needs


HIV Treatment of MTCT Population
Daily Workload MTCT Manpower Equipment

Rapid Tests

50/Technician 10/Counselor 200/Technician

60,000

HIV ELISA

+6 ELISA Setups

CD4

30/Technician

24,000/32,000

(8/10) 18 Technicians (8/10) 18 Technicians

+4 Flow Setups

Viral Load

30/Technician

24,000/32000

+4 units

CD4 testing Frequency


Initial visit If CD4 > 500 and viral load 10,000-20,000, every 6 months

If CD4 350-500 and viral load 10,000-20,000, consider ART


If CD4 < 200, recommend ART

IDSA recommendation, 2000

CD4 Technology Options


Flow Cytometry
Single platform Double platform

EIA
Microscopy

CD4 QA Considerations
Stored and transported at room temperature Tested within 72 hours Proficiency testing

Comparison of Viral Load Methods


RT-PCR
Manufacturer Analytical sensitivity (copies/ml) Accuracy range Roche Amplicore Ultrasenitive 400 50 400-750,000 50- 5,000 0.3

b-DNA
Chiron 500

NASBA
Organon-Teknika 4,000

500-1,000,000

4,000-2,000,000

Inter-run reproducibility Anticoagulant

0.3

0.3

EDTA/ACD

EDTA

EDTA/ACD/ Heparin

Viral Load Testing Frequency


Baseline: 2 measurements, 2-4 weeks apart During therapy:
Routinely 3-4 months Shorter as critical decision points near 1-3 months after changing therapy

Inappropriate Test Usage


Initial diagnosis of HIV infection Emphasis on a single specimen result Mixing multiple test systems or anticoagulants

Other Works Consulted

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