HIV Testing Algorithm (Fourth Generation Screening Assay)

Including Follow-up of Reactive HIV Rapid Serologic Test Results

A Suspect acute HIV infection

HIVCO / HIV-1 and HIV-2 Antigen and Antibody Reactive results from: in high-risk patient
Evaluation, Serum. If indicated, all subsequent tests listed ■ Rapid HIV-1 test

are automatically performed and charged separately ■ Rapid HIV-1/-2 test

REACTIVE specimens HIVQU / HIV-1 RNA Quantification, Plasma

from 3rd generation OR
HIV-1/-2 antibody PHIV / HIV-1 RNA Proviral DNA Qualitative
screening tests* REACTIVE NegAtive Detection by PCR, Blood

Positive NegAtive

HIVDI / HIV-1 and HIV-2 stoP If suspecting acute HIV infection At risk for At risk for
Antibody Differentiation, Serum Repeat HIVCO in 2 to 4 HIV-1 infection1
in high-risk patient, see inset A HIV-2 HIV-1
weeks for at-risk patients

FHV2Q / HIV-2 DNA / RNA Repeat serologic

Qualitative Real-Time PCR testing HIVCO if
HIV-1 Ab Positive HIV-1 Ab Negative HIV-1 Ab Indeterminate HIV-1 Ab Reactive HIV-1 Ab Unreadable HIV-1 Ab Negative clinically indicated
HIV-2 Ab Negative HIV-2 Ab Negative HIV-2 Ab Negative HIV-2 Ab Reactive HIV-2 Ab Unreadable HIV-2 Ab Reactive
Positive NegAtive

HIV-1 infection1 If suspecting acute HIV ANd HIV-2 infection2 Repeat serologic testing HIVCO in
HIV2L / HIV-2 Antibody
infection in high-risk 2 to 4 weeks if clinically indicated
Confirmation, Serum
patient, see inset A
HV1WB / HIV-1 Antibody Confirmation
by Western Blot, Serum

Positive NegAtive B

HIVFA / HIV-1 Antibody Confirmation

If suspecting acute HIV
Indeterminate by Immunofluorescence, Serum
Positive NegAtive infection in high-risk HIV-2 infection 2
If suspecting acute infection
or Unreadable
patient, see inset A in patients at risk for HIV-2
infection, consider FHV2Q Positive iNdetermiNAte NegAtive
HIV-1 infection 1 Consider HIVFA,
see inset B

HIV-1 infection1
Repeat testing If suspecting acute
Order Options Unit Code in 2 to 4 weeks if HIV infection in
Tests Performed HIVCO HIVDI HIVFA HV1WB clinically indicated high-risk patient,
see inset A
HIV-1 and HIV-2 Antigen and Antibody Evaluation, Serum x
HIV-1 and HIV-2 Antibody Differentiation, Serum x x
HIV-1 Antibody Confirmation by Western Blot, Serum x x x
HIV-1 Antibody Confirmation by Immunofluorescence, Serum x
HIV-2 Antibody Confirmation, Serum x x

*Specimens from individuals with reactive results from 3rd generation HIV-1/-2 antibody screening
tests can enter this testing algorithm at HIVDI with applicable downstream testing.
1
For verification, submit specimen for HIVQU (preferred) and/or HVIWB
2
For verification, submit specimen for HIV2L and/or FHV2Q
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