There is life with HIV

look! There is life with HIV

Recent or old HIV infection? How to define

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Guidelines for universal HIV testing have been around for a long time. However, many people do not get tested for HIV regularly. 

This means that, when someone is diagnosed with a new HIV infection, they can ask themselves if there is any way of knowing when they were infected or who infected them.

Infecção por HIV recente
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Diagnosing new and old HIV infections

There are several ways for doctors to determine whether a person who has recently been diagnosed how HIV positive is also infected. In rare cases, when the test is done too early, doctors find people who are positive for viral RNA or p24 antigen, but who are not yet positive for antibodies.1 

These are the individuals in the early stages of HIV infection.

However, they will not be detected in many standard antibody-based HIV tests. Therefore, these early diagnoses of HIV infection are somewhat unusual.

Most often, doctors are trying to determine whether a person who has tested positive for HIV has recently been infected or not. These people already have antibodies against the virus. Therefore, your doctors are required to examine certain specific characteristics of these antibodies. These characteristics will be different in people with new HIV infections than in people with already established infections.

Details! The Devil lives in the details!

The characteristics of antibodies that doctors examine to detect HIV infections incidents include:

  • The type of antibodies present: different isotypes of antibodies appear at different times
    Infecção por HIV recente
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    after exposure to a pathogen. For many diseases, it can be useful in determining whether a person is newly infected or not. However, IgM antibodies, which are generally used to detect new infections, may also have been present in people infected with HIV for some time. Therefore, this is not always as useful for staging HIV infections as doctors would like. (However, this can sometimes be used to distinguish between Herpes infections by.)

  • The number of antibodies present: After antibodies begin to appear in response to an HIV infection, they increase over a period of several months. Then they start to level off. If these changes can be detected, it could be a sign of a relatively recent infection.
  • Which HIV proteins do antibodies bind to: As HIV infection progresses, the relative amounts of antibodies to different HIV antigens change. You can use this to determine whether someone has an early or late HIV infection.
  • How antibodies bind strongly to HIV: Individuals newly infected with HIV generally have antibodies that bind less strongly to HIV than people with already established infections.2However, people who started treatment soon after infection may also have similarly low antibodies greed.

The standard HIV test cannot distinguish between new and old infections

In conclusion, it is possible for doctors to determine whether their new HIV diagnosis is the result of a new infection or an older infection. However, this information cannot be determined by the standard HIV test. Determining whether a newly diagnosed infection is a new HIV infection is most often done by people working on HIV surveillance. It is not a normal part of patient care. Therefore, if you have recently been diagnosed as HIV positive and are concerned about the date of seroconversion, you may need to speak to an infectious disease specialist about additional testing. Not every doctor will know or have access to the necessary technology.

In fact, most of the time, doctors will not do these forms of testing on newly diagnosed patients - even if requested. Generally, one is considered to have a acute infection (i.e., recent transmission) only when the test was performed and was negative in the previous year. Newly diagnosed HIV-positive patients who have not been tested regularly often simply cannot find out whether they have been recently infected.

Newly Infected Versus Newly Diagnosed

It is important to mention that there are some other circumstances in which individuals end up being categorized as newly infected rather than just recently diagnosed.

  • If a person has anti-HIV antibodies and is RNA positive, but his W it is indeterminate. This is believed to be a sign of acute infection.3These cases can be detected using confirmatory test algorithms used to detect HIV.
  • When a person tests positive for viral RNA, but still does not produce anti-HIV antibodies.3However, not all HIV tests include an RNA test, so these cases are easily missed.
Why is the detection of new HIV infections important?

Infecção por HIV recente
Time. Time still seems to define us

Is important diagnose new HIV infections when are still new. This can significantly reduce the spread of HIV. For various reasons, people are at a very high risk of transmitting HIV to their sexual partners weeks, months or years before they know they are HIV positive.

The first reason that people with HIV can be more dangerous to their partners before they have tested positive is obvious. If they are not aware of their risks, they may be unmotivated to practice safe sex.

The second is that newly infected individuals generally have higher viral loads and are more infectious than people infected a long time ago.

This increases the chance of transmission of the virus during any specific encounter. The third is that if you have not been tested, you are not being treated. The treatment greatly reduces the risk of infecting your partner. In fact, it is now used as a form of prevention.6 

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Translated by Original Claudio Souza in Distinguishing Between New HIV Infections and Old Ones (Opens in another tab)

Article sources

  1. Peters PJ, Westheimer E, Cohen S, et al. Yield of HIV antigen / antibody combination screening and combined HIV RNA test for acute HIV infection in a high prevalence population. JAMA. 2016; 315 (7): 682-90. doi: 10.1001 / jama.2016.0286
  2. Overbaugh J, Morris L. The Antibody Response against HIV-1. Cold Spring Harb Perspect Med. 2012; 2 (1): a007039. doi: 10.1101 / cshperspect.a007039
  3. Hurt CB, Nelson JAE, Hightow-weidman LB, Miller WC. Selecting an HIV test: a narrative review for doctors and researchers. Sex Transm Dis. 2017; 44 (12): 739-746. doi: 10.1097 / OLQ.0000000000000719
  4. Volz EM, Ionides E, Romero-Severson EO, Brandt MG, Mokotoff E, Koopman JS. Transmission of HIV-1 during initial infection in men who have sex with men: a philodynamic analysis. PLoS Med. 2013; 10 (12): e1001568. doi: 10.1371 / journal.pmed.1001568
  5. Selik RM, Linley L. Viral loads at 6 weeks after diagnosis of HIV infection in early and later stages: observational study using national surveillance data. JMIR Public Health Survey. 2018; 4 (4): e10770. doi: 10.2196 / 10770
  6. Cohen MS, Smith MK, Muessig KE, Hallett TB, Powers KA, Kashuba AD. HIV-1 antiretroviral treatment prevents HIV-1 transmission: where do we go from here? The Lancet. 2013; 382 (9903): 1515-1524. doi: 10.1016 / s0140-6736 (13) 61998-4

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