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HIV and AIDS DiagnosisHIV tests are usually given to people who believe they may have been exposed to HIV and decide to get tested. The tests are also given to people with HIV who need to have their condition monitored. In September 2006, the Centers for Disease Control and Prevention (CDC) revised its HIV testing recommendations as follows: - All people at high risk for HIV infection should be screened for HIV at least annually.
- All people seeking treatment for TB or STDs should be screened routinely for HIV.
- HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women.
Until the HIV test results are returned, the CDC recommends that people consider abstinence or using condoms and/or dental dams during all sexual encounters. HIV Antibody TestsThe immune system produces antibodies in response to an HIV infection. Because it takes an average of two weeks for the tests to detect the HIV antibody, people should be tested one to three months after exposure to the virus. The following tests are used to diagnose an HIV infection by detecting the presence of HIV antibodies: ELISA and Western BlotELISA (enzyme-linked immunosorbent assay) detects antibodies to the HIV virus in a blood sample. The test is highly sensitive but false positives are possible. All positive test results need to be confirmed by the more specific (and expensive) Western blot test, which tests for the presence of HIV proteins. Oral Mucosal Transudate TestThe oral mucosal transudate test uses the same technique as ELISA and Western blot to test for the presence of HIV antibodies in an oral fluid called oral mucosal transudate (OMT). OMT is collected by gently rubbing a specially treated pad between a person's gum and lower cheek. The test doesn't check for HIV antibodies in saliva. Urine HIV Antibody TestThe urine HIV antibody test uses the same technique as ELISA and Western blot to test urine for HIV antibodies. Rapid HIV Antibody TestOne problem with most HIV antibody tests is that the results can take as long as two weeks. This test uses either blood collected from a person's fingertip or oral fluid specimens collected by swabbing gums. Test results are available within 20 minutes. All positive results need to be confirmed with a more specific test, such as the Western blot. Four rapid HIV antibody tests licensed by the FDA are: - OraQuick Rapid HIV-1 and Advance HIV ½ Antibody Tests
- Reveal G2 HIV-Antibody Tests
- Multispot
- Uni-Gold Recombigen
Home Testing KitA home testing kit enables people to collect their own blood samples at home and mail them to a laboratory for testing. To date, only the Home Access test is approved by the Food and Drug Administration. People prick their fingertip, place drops of their blood on a specially treated card, and mail the card to a licensed laboratory for testing. People are assigned an identification number they can use to receive their test results by telephone, U.S. mail, or e-mail. Monitoring an HIV InfectionTest results reveal the current status and progression of an HIV infection. The following tests are given when HIV is first diagnosed to indicate the current status of a person's health at the start of antiretroviral therapy. The tests are then used throughout the antiretroviral therapy to monitor a person's health and adjust the therapy accordingly. Viral load testThe viral load test measures the number of copies of HIV present in a person's blood. A rising viral load count indicates a worsening HIV infection and a falling viral load count indicates the HIV infection has been suppressed. CD4 testThe CD4 test measures the number of CD4 cells (immune system cells) in the blood. The test is usually given at the same time as the viral load test. In general, the CD4 count goes down and viral loads go up as HIV disease progresses. HIV drug resistance testResistance to antiretroviral drugs develops when HIV mutates (changes form). When this occurs, the current treatment is no longer able to control the HIV infection and the virus starts multiplying rapidly. Because people with HIV take several antiretroviral drugs simultaneously, HIV drug resistance testing is used to identify which medication has stopped working. If drug resistance is identified, a person's antiretroviral therapy needs to be modified accordingly. Drug resistance is not the only cause of rising HIV levels. Other causes include drug abuse, alcohol use, poor medication absorption, or people not taking their medications as directed. Basic laboratory testsAdditional laboratory tests help monitor the status of a person's overall health. These tests include: - Blood chemistry profile, including liver function tests
- Complete blood count
- Opportunistic infections (such as hepatitis and tuberculosis)
- STDs (sexually transmitted diseases)
HIV Test Result ReportingHIV test results can be anonymous, confidential, or name based: - Anonymous
Anonymous testing means that a person's name is not recorded at the test site. - Confidential
Confidential HIV testing means that only healthcare providers have access to a person's name. The test result but not the name is then reported to local public health officials. This enables the government to track the disease in the population as a whole but protects a person's identity. - Name-based
The names of HIV-positive people are reported to local public health officials. Most states provide the federal government with the names, while a few provide unique codes instead of names. In both cases, the names are not given to insurance companies or employers.
Some people prefer to use anonymous test sites to avoid having their name reported to the government. When they get treated for their HIV infection, however, their healthcare provider is required to report the names of all people who test positive for HIV to the local government. Policies about anonymous and confidential HIV testing in the United States are determined by the states. The CDC recently urged all states to collect and report HIV infection data by name. This is now the case in the majority of states. The Henry J. Kaiser Family Foundation compiled the following state-by-state information from the "Current Status of HIV Infection Surveillance," The Centers for Disease Control and Prevention (CDC), as of February 2007: HIV testing options by state- Anonymous and confidential testing both available
Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming - Confidential testing only available
Alabama, Idaho, Iowa, Mississippi, Nevada, North Carolina, North Dakota, South Carolina, South Dakota, Tennessee.
HIV test reporting to the federal government by state- Code-based reporting to the federal government
Hawaii, Maryland, and Vermont offer code-based reporting. - Name-based reporting to the federal government
All states other than Hawaii, Maryland, and Vermont offer name-based reporting.
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