How is the HIV Test?
What to expect when doing an HIV test An HIV test is used to determine whether you have been infected with the human immunodeficiency virus (HIV). It is usually performed on a blood or saliva sample. But a new urine-based test was approved in the United States in 2015. However, testing options at the point of care are extremely accurate if used correctly. Or they can return a false-negative result if you test very early after an exposure.
There are approximately 1,2 million people living with HIV in the United States. And 25% of them remain undiagnosed. In 2018, 38.686 adults were infected with the virus. In response, the United States Task Force has issued updates and guidelines recommending that all Americans aged 15 to 65 undergo HIV testing as a natural part of a routine doctor visit, such as a physical exam. This is also recommended for pregnant women, to prevent transmission of the virus from mother to child. Thus, ideally, people at high risk of infection are tested every three to six months and can be recommended for many vulnerable groups, including:
- Gay or bisexual men sexually active
- Injecting drug users
- Sex workers
- Anyone who has high-risk sex, including sex without a condom or with multiple partners
But look, an HIV test can also be performed after someone becomes aware of HIV positive status of a partner, or ex-partner / partner, and during a medical evaluation after sexual assault.
Types of HIV Tests and What They Evaluate
There are indirect and direct methods of detecting HIV. Indirect methods do not detect the virus, but proteins, called antibodies. And these are produced by the immune system in response to the virus. Direct test methods detect antigens (proteins on the surface of the virus) or RNA (genetic material of the virus). There are a few test options, which vary in speed, accuracy and ease of use:
- Rapid tests at the point of care can provide preliminary results in about 20 minutes. This needs a drop of blood from the finger or a sample of saliva. Saliva is obtained with an oral gum swab.
- these tests, urine tests, are not in use in Brazil!
- Of these, the preferred method is the blood-based HIV antigen / antibody (Ag / Ab) test.3
- Standard tests on COAS they are laboratory-based tests that detect only anti-HIV antibodies.
These tests can make a lot and a lot of difference in your lives!
Because the prognosis for treatment success is better when the problems are perceived in the beginning. And see, this is true for any and all health problems or your day-to-day! Problems must be faced head on!
- Also known as HIV ELISA, the test requires a blood sample.
- Results are usually returned within five to 10 business days.
- Currently, the test is less used today and has been largely replaced by the combined HIV Ag / Ab combination test.
- The rapid domestic tests. These they are tests that search for antibodies that analyze saliva that can be purchased online or at many retail pharmacies. Although less accurate than a test at the point of care, the test offers privacy and can provide results in about 20 minutes.
I Claudio think the idea of testing yourself at Home is hardly adequate
- Home collection kits it can also be purchased online. This antibody test requires a drop of blood placed on a test card, which you send to a laboratory by express mail. You can receive results by phone or online within one business day after sample delivery.
- Nucleic acid tests (NAT) are blood-based tests that detect HIV RNA. Although expensive, NAT can detect HIV earlier than other forms of testing and may be appropriate if you have recently had high-risk exposure or are experiencing acute symptoms of early infection. NAT is also used to screen donated blood or test newborns with suspected HIV. The results are usually returned within a few days.
Any result called positive is preliminary and requires a second confirmatory test to ensure the diagnosis is correct. The only exception is NAT, which requires confirmation.
Accuracy of HIV tests
Os HIV tests are highly accurate if used correctly. However, some test methods are more reliable than others. Inappropriate collection or storage of samples can also impair the accuracy of a test.
In general, tests at the point of care are more accurate than home tests (due in part to the error of the home user), while blood tests tend to be more accurate than tests done on saliva or urine (due to the higher concentrations HIV in patients and blood). Clinics in the United States report a 98,5% accuracy rate when using an antibody test and a 99,9% accuracy rate when combined with a confirmatory test. This translates that a false positive results from these routines after every 250.000 tests. Keep in mind that, if you have a reagent result, the final reagent HIV infection is not a death sentence today New generation tests promise even better results. Certain illnesses can also trigger an HIV test result with positive results for a person who is not really infected. Diseases that can trigger a false positive include syphilis, lupus and Lyme disease. Confirmatory tests often eliminate these incorrect findings.
Risks and Contraindications
There are no contraindications for HIV testing and there are few risks. If blood collection is required, you may experience pain, swelling and bruising at the injection site. Dizziness and an infection are also possible. If you are afraid of needles or are sensitive to blood, inform the nurse or phlebotomist in advance. Other test options may be available. In addition, if you have hemophilia or are taking anticoagulants, a butterfly-type “blood flow access” in a size appropriate for children can be used to reduce the risk of bleeding.
Before HIV testing
HIV testing requires no preparation other than your readiness to be tested. That said, HIV remains a highly stigmatized disease, and people often avoid testing for fear of being reported. If you are concerned about your privacy, CTAs and COAS conduct confidential tests and this confidentiality is protected by law. The violation of this confidentiality by someone has serious legal consequences and there are many reasons for the confidentiality to be maintained. In addition, the disease is stigmatized. The health professionals who work in this specific area of health do work for the sake of the cause and in 20 years I have only met two people "like this", unable to not put themselves in other people's shoes. I always say: to friends, everything! To enemies, the law!
How long does it take to know the result of these tests?
O time is an important part of HIV testing. If you have been infected with HIV, there will be a time, called the immune window period, when the test cannot provide an accurate result. Since HIV tests usually detect antibodies and / or antigens, you need to wait until your body produces enough to get a positive result. If you test too early, you will receive a reading false-negative. Even with NAT, you need to wait until the virus is replicated to detectable levels. Since detectable levels can vary from person to person, most clinics advise that you wait to get tested for HIV after possible exposure: One right after the possible exposure, to resolve the doubt that you were infected in a previous situation
THE IMMUNOLOGICAL WINDOW NEEDS TO BE RESPECTED! AND NOT FEARED
And another after the immune window! The procedure itself involves three steps:
- pre-test counseling,
- HIV test
- and post-test counseling.
Depending on the test being performed, the process may take some time; the rapid tests tell the result in real time and, yes, they are reliable!
Os HIV tests are available at many medical and public health facilities. This includes hospitals, clinics, retail pharmacies, community HIV organizations, prenatal and family planning clinics, youth reception centers, mobile testing sites and drug and alcohol treatment centers. It is good to reiterate that pregnant women are entitled to the test as soon as their pregnancy is confirmed. It is a right and a duty towards your baby, as the pregnancy of the well-assisted HIV-positive mother prevents the birth of children with HIV
Food and drink.
There are no dietary restrictions for an HIV test. However, if you are using an oral test at home, avoid brushing your teeth or using a mouthwash 30 minutes before the test, as this can indeed affect the results.
What to take?
Even if you are undergoing anonymous testing, the establishment may require a government-issued ID to confirm your residency. Call ahead for details. You should also check if they accept your insurance, if you have a plan. In that case, bring your insurance card. You can also take someone with you if you are not sure how to react to a positive HIV diagnosis. Having support can be very important. I reinforce: It is good to know and, yes, what I say on my blog is serious: there is life with HIV!
It is a mistake to think that there is nothing you can do if you have been exposed to HIV recently. If you have had sex without a condom, shared needles, or have some other form of high-risk exposure, you can prevent infection by starting post-exposure prophylaxis for HIV within a maximum of 72 hours. PEP involves a 28-day course of two or three antiretroviral drugs, depending on the severity of your exposure. Used by health professionals and in cases of rape, the strategy can reduce the risk of infection by up to 79%.6 HIV Post-Exposure Prophylaxis. There is a consensus in Brazil that PEP taken with complete adherence always avoids seroconversion! So my reader, my reader, do not abuse. In my case, exposures were repeated and repeated; I was not afraid, believe that having HIV represented dying and, in those days, dying, well, death was something I seemed to be looking for ... But it is not like that, and nowadays, not at all!
Pre-test counseling is carried out in a private room with a qualified health professional. During counseling, you may be asked about recent exposure, if any, as well as your sexual or recreational practices. The questions are not meant to judge or embarrass you (I remember Maria Alice doing my social profile, devastated, when the sensibility noticed and told me -You don't need to be embarrassed! This is not the reason for all this!); they are there to help assistant is there to understand you, check what you need and, I say this: Although I know only two social workers, Susan and Analice, I know that there are people who learn this profession and become “social hinderers”! Don't lose your pulse and make these bad professionals understand who you are and that you know you have your rights! Ask your questions, try to understand better what is going on, as it is your right to better understand your personal risk of infection. Feel free to ask any questions you need. There is no bad question and informed consent is your right!
During the test
The test procedure at a clinic can vary depending on whether you are taking a rapid blood or oral test for HIV or a blood or saliva test for HIV antibodies. (The urine test, while approved, is rarely used in a clinical setting, partly because it is less accurate than any other test.) A rapid blood test for HIV is performed as follows:
- Your finger is cleaned with an antiseptic cloth.
- Using a spring-loaded tool called a lancet, the healthcare professional pricks your finger to draw a drop of blood.
- The blood is collected in a small glass tube called a pipette, which is then placed in a reagent called a buffer.
- The tampon and two other chemicals (a dying agent and a cleaning solution) are poured into a plastic well called a membrane.
- After 15 to 20 minutes, the membrane is checked. If the membrane has a dot on the bottom, the test is not reactive (negative). If the membrane have hurts points, the test is reactive (preliminary positive).
- A confirmatory blood test is then performed; the results are available a few days later.
A quick oral HIV test is performed as follows:
- An oral swab called a wand is slid between the teeth and the upper and lower gums. The wand should not be passed more than once.
- The wand is placed in a buffer solution for 20 minutes.
- This wand has a results window similar to a home pregnancy test. If the window in the identifier has a line, the test will not be reactive (negative). If the window has two lines, the test is reactive (preliminary positive).
- A confirmatory blood test is then performed. You will get your results the same day you take the test.
A blood test for the anti-HIV antibody is performed as follows:
- A rubber band is placed on the upper arm to swell the vein.
- The skin around the planned injection site is cleaned with an antiseptic swab.
- A wing-shaped device called a butterfly needle is inserted into the vein. This needle, which is attached to a narrow catheter, is less likely to shake as blood is collected than other types.
- Between 1 and 4 milliliters (mL) of blood are drawn into a vacuum-sealed test tube called a vacutainer.
- The needle is then removed and the arm is bandaged.
- The tube is sent to a laboratory. If the sample is reactive (preliminary positive), the laboratory immediately runs a confirmatory test using the same blood sample.
- You will be informed of your results in a week or two.
An HIV ELISA saliva test is performed as follows:
- An oral swab called a wand is placed between the cheek and gums for two to five minutes.
- The wand is placed in a buffer solution.
- The handle of the wand is then removed.
- The buffer solution is sealed and sent to the laboratory.
- If the sample is reactive (preliminary positive), the laboratory immediately runs a confirmatory test using the same sample.
- You return to the test results in a week or two.
After the test
Some people will tell you that the most difficult part of an HIV test is not getting tested, but waiting for the results. This is especially true if you have a preliminary positive result and need to wait several days or more for the final results. The wait can often be distressing; so much so that, in fact, one in 15 people will not return to their results, according to a study published on International Journal of STDs and AIDS.7 There are several things you can do to maintain your composure while waiting:
- Surround yourself with friends and family who support you.
- Take it one step at a time. Don't spend hours searching the web every "what if".
- Exercise to help lift your mood and fight depression.
- Avoid alcohol, recreational drugs or even caffeine to remain calm and present.
- If the worry starts to consume you, remember that there is effective treatment and that our Constitution guarantees the Right to Health and Treatment guarantees your health. AND HAVE IN MIND: PEOPLE WITH HIV ARE NOT EXPENSES. CORRUPT POLITICS AND THEIR WAGES, YES !.
If you are unable to deal with this and have no one to talk to, contact me or Beto | Volpe via WhatsApp in your state to get a referral to a qualified counselor in your area.
Interpretation of results
The time required to obtain the results may vary. HIV test results are not sent by post. The test results are interpreted as follows:
- If the preliminary test is not reactive, you are HIV negative, which means that you have not been infected or tested too early. Although you do not need further testing (unless the timing of the test is not ideal), you will be advised on ways to reduce your future risk and whether routine testing is necessary if you are at high risk of infection.
- If the preliminary test is reactive, the result will be considered a preliminary positive. To confirm the result, the laboratory will use a more sophisticated test called the HIV differentiation test and possibly NAT. If confirmatory tests are not reactive, you can guarantee with a high level of confidence that you are HIV negative.
- If your preliminary and confirmatory tests are reactive, you are HIV positive, which means you have been infected with HIV. Post-test counseling will focus on your emotional and medical needs.
Post-test counseling is always carried out, regardless of the test results. The goal of counseling is twofold: to help you understand what the results mean and to provide the “what's next” information you need to stay safe and healthy. A positive HIV test result will be shared with the Ministry of Health and your doctor, or certain people, according to the rules you agreed to before your test. If your confidentiality is breached, you can file a complaint with the prosecutor and seek legal damages, in accordance with your state's laws.
When you are diagnosed with HIV positive, you will be advised that treatment options and support systems exist to link you to medical care. You can also be referred to a social worker who can help you with referrals and any necessary emotional, family, legal or harm reduction support services. If you feel overwhelmed, you can request a discussion about these things on another day or use the time to ask as many questions as necessary. Accepting an HIV diagnosis is a process. Don't feel rushed.
The immune window may have become simpler for you. Read it and understand
And I affirm and reaffirm: There Living with HIV
Examinations of CD4 count e viral load will be some of preliminary exams you will have to do And it is important that you understand that the fact that, in the future, when you have Undetectable Viral load, this will not change your HIV test result for non-reagent. Unfortunately that is how I went on living and, try to understand, it is better to face the problem face to face, with your eyes on this thing! And understand one thing: YOUR BLAME, YOUR REMORSE, YOUR SHAME WILL NOT MAKE YOUR IMMUNOLOGICAL WINDOW TO PUNISH YOU. You are = a simple human being and a simple human being! And it is prone to errors and mistakes! If you asked your partner because of that, think about Renato usso vantamdo, in one of his last albums the song L'A ventura:… ”sad thing is good for those who don't know how to forgive”… And when I say that there is life with HIV it is because there is. Cure for HIV? I don't think about healing for me! But she was already achieved by some people em risky processes Translated by Claudio Souza's original How HIV Is Diagnosed! With information from these articles
- Centers for Disease Control and Prevention. HIV Surveillance Report 2018.
- US Preventative Services Task Force. HIV.
- Arora DR, Maheshwari M, Arora B. Rapid Point-of-Care Testing for HIV Detection and Clinical Monitoring. ISRN AIDS. 2013;2013:287269. doi:10.1155/2013/287269
- Food and Drug Administration. First Rapid Home-Use HIV Kit Approved for Self-Testing.
- National Institutes for Health. HIV Testing Overview.
- HIV.gov. Post-Exposures Prophyalxis.
- Laanani, M .; Dozol, A .; Meyer, L. et al. Factors associated with failure to return for HIV test results in a free and anonymous screening center.Int J of STD AIDS. 2014;26(8):549-55.
- Pant Pai, N .; Balram, B .; Shivkumar, S. et al. Head-to-head comparison of accuracy of a rapid point-of-care HIV test with oral versus whole-blood specimens: a systematic review and meta-analysis.Lancet Infect Dis.2012;12(5):373-80. doi: 10.1016/S1473-3099(11)70368-1
- Thomas, R .; Galanakis, C .; Vezina, S. et al. Adherence to Post-Exposure Prophylaxis (PEP) and Incidence of HIV Seroconversion in a Major North American Cohort.PLoS One. 2015; 10 (11): e0142534.doi: 10.1371 / journal.pone.0142534
- US Department of Health and Human Services. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Washington, DC; updated July 6, 2018.
- US Preventive Services Task Force. Human Immunodeficiency Virus (HIV) Infection: Screening. Rockville, Maryland; updated April 2013.
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