How is HIV Diagnosed?
In the first few months, HIV victims will have flu like symptoms, such as headaches, fever, swollen lymph glands (in some cases), and fatigue. As time goes on, the disease may make itself known through the presence of uncommon diseases, which are normally kept in check by the immune system. One prevalent site for uncommon diseases to manifest is in the mouth.
If HIV is suspected, routine blood tests can determine whether HIV antibodies are present in the body (this is a process that takes around 6-12 weeks), as well as tests involving urine or saliva (arguably less reliable).To avoid a false reading, a minimum of two tests are used in case the disease has not had enough time to progress.
HIV Testing Options
Home kits are available at any local pharmacy, and they can be used in private. Home kits allow testers to collect blood samples (which are applied to a special card) so that they can send them to a private lab. Users are given a private reference number that they can use to obtain results with the lab later. Those who test positive will be given access to pamphlets and information, and they will be encouraged to follow up with an official HIV test (HIVTest.CDC).
Rapid test uses oral fluids, or blood to test for HIV antibodies. They are a low-tech method that does not require machinery to produce results (Point-of-Care Rapid Tests for HIV Antibody). This method relies on the reactions of fluids. Screening is usually completed in 20 minutes. If the reading is positive, a second test is necessary to ensure accuracy of the result. It is markedly cheaper than an enzyme immunoassay, and it is widely used in Africa (Point- of-Care Rapid Tests for HIV Antibody).
Enzyme-linked immunoassay is a test that compares blood samples against particular antigens and antibodies. The color changes (enzyme reactions) from the test determine the result (ELISA, MedlinePlus Medical Encyclopedia). A follow up Western blot test is administered to prevent false readings (ELISA, MedlinePlus Medical Encyclopedia). Enzyme-linked immunoassay tests normally report negatives if the test is sought too early. Blood is obtained by venipuncture.
Oral fluid and urine tests are usually screened through enzyme immunoassay, and confirmed later with a Western blot test. These tests focus on detecting antibodies in the content of the samples. Urine is reportedly less accurate than oral fluid (HIVTest.CDC).
Western blot test is a test that looks for specific antibodies in samples, isolates them, and compares them to other stored samples. If they match, it can indicate a positive HIV test. Like the enzyme-linked immunoassay, readings are normally false if the patient is tested too early. This is mainly used as an assistive diagnostic tool (Human Immunodeficiency Virus HIV-1 Western Blot).
Note: RNA screening tests for HIV are available but they are not widely used. These types of tests attempt to detect HIV genetic material.
Opt Out Recommendations
The revised CDC guideline (2006) encourages routine HIV testing, and less invasive forms of consent to promote testing. Here is a list of recommendations to follow if you wish to abide by better opt out testing standards with your patients:
- All mothers should be routinely tested for HIV as part of the prenatal testing process, however, though the tests are routine mothers must be allowed to decline if they wish. You must never force testing. Additionally, mothers should be informed about HIV and why your facility is testing for HIV. You can use oral or written sources of information to explain HIV, what you are testing for, and how results are read. No other method of consent is necessary if you already have gained general consent. If the mother declines, document the mother's request in her medical file.
- When the patient needs a translator to discuss HIV testing do not use family members as interpreters. The facility must be able to provide a translator to satisfy HIPAA privacy law requirements. Never assume that patient wants to discuss matters with their families, unless they have provided consent. Having pamphlet material available in another language can provide a better degree of understanding.
- Adults and adolescents must be informed before they can consent. They must be told that they can opt out of testing as well, and what the procedure is to decline. Questions and having available information on hand (e.g. pamphlets etc) are encouraged. Florida does not require parental notification in the event that their child has been provided HIV testing and counseling.
- STI (sexually transmitted infection) clinics should test for HIV, even when testing is meant for other diseases, such as hepatitis B. If the patient already has STI infections this can increase HIV infection rates. By explaining the risk of HIV co-infections, this will help obtain patient consent for an HIV test, and decrease resistance from what might appear to be a seemingly unrelated test.
- HIV testing results should be delivered in the same manner as are other diagnostic tests.