9/13/11 Learning Issue HIV Testing Case #2: Sara Newton HIV Testing Background1 Typically Ab tests that

at detect HIV Abs made in response to HIV infection A window period b/t infection and Ab detection varies in individuals o Usually 2-8 weeks long (avg. 25 days) o 97% will develop detectable Abs w/in 1st 3 months o Likelihood of transmission during this window is HIGH o IMPORTANT that follow-up test is performed > 3 mos. after last potential exposure All (+) HIV results MUST be confirmed by a 2nd HIV test (i.e., Western blot or immunofluorescence assay) Who Should Get Tested? 5 behaviors that put you at risk for HIV (as outlined by CDC): o Injecting drugs/steroids, sharing needles/syringes o Having unprotected vaginal, anal, or oral sex with men who have sex with men, multiple partners or anonymous partners o Exchanging sex for drugs/money o Being diagnosed with or treated for hepatitis, TB, or an STD o Having unprotected sex with someone who can performs any of the above behaviors All pregnant women are encouraged (risk-based testing misses many infected women) Types of HIV Tests HIV Ab tests (EIA Enyzme Immunoassay) o Conventional method; results in 1-2 weeks o Blood samples (usually); oral fluid & urine samples can be taken also RNA tests o Detect genetic material of HIV directly o In cases of rare, very early infection when Ab tests unable to detect HIV Abs o Window period b/t 9-11 days; more costly Rapid HIV test (4 types available in US, 2 approved for clinical use)3 o Blood sample from vein or finger prick, or oral fluid o Results in 20 minutes; interpreted visually o HIV Abs in blood bind HIV Ags on test strip; color reagent binds HIV Ab, allowing detection o Negative predictive value is HIGH -> pt w/ (-) HIV test can be told he/she does not have HIV o Price range: $14-$25 Home Testing Kit (Home Access HIV-1 Test System) o Sold at local drug stores o Actually a home collection kit, not true home test o Prick finger, put blood on card, mail card into lab, call in for results What Happens if the Test Result is (+)? MUST BE VERIFIED with 2nd, supplemental, confirmatory HIV test (1) See a doctor to discuss possible treatment options, (2) get a TB test, (3) abstain from smoking, drinking, illicit drug use, (4) get screened for other STDs, (5) avoid transmitting HIV to others.

References 1. http://www.cdc.gov/hiv/topics/basic/ 2. http://www.cdc.gov/hiv/topics/testing/resources/qa/index.htm 3. Greenwald JL, Burstein GR, Pincus J, Branson B. A rapid review of rapid HIV antibody tests. Curr Infect Dis Rep. 2006 Mar;8(2):125-31. PubMed PMID: 16524549.