eMedicine Specialties > Emergency Medicine > Infectious Diseases

HIV, Early Recognition and Rapid Testing: Differential Diagnoses & Workup

Author: Jeff Dubin, MD, Medical Director, Emergency Department, Washington Hospital Center, Assistant Professor, Department of Emergency Medicine, Georgetown University School of Medicine
Contributor Information and Disclosures

Updated: Apr 7, 2009

Differential Diagnoses

Candidiasis
Mononucleosis
Cytomegalovirus
Pharyngitis
Idiopathic Thrombocytopenic Purpura
Syphilis
Influenza
Viral Hepatitis
Meningitis

Other Problems to Be Considered

Pediatric AIDS
Needlestick guidelines

Workup

Laboratory Studies

  • Complete blood count
    • Leukopenia
    • Thrombocytopenia
  • Hepatic function tests - Elevated transaminase levels

Other Tests

Rapid HIV tests

  • Test for HIV antibodies with an enzyme-linked immunosorbent assay (ELISA).
  • Several rapid tests are available in the United States.
    • Sensitivity and specificity are greater than 99%.
    • Rapid test kits results are reported as reactive or nonreactive.
Table. FDA-Approved Rapid HIV Tests

Open table in new window

Table
FDA-Approved Rapid HIV TestOraQuick AdvanceUni-Gold RecombigenClearview  Stat-Pak and CompleteReveal G-3Multispot
Specimen NeededOral swab or blood (fingerstick)Whole blood
(fingerstick)
Whole blood
(fingerstick)
Serum
plasma
Serum
plasma
Turnaround Time (minutes)201015310
CLIA* RequirementWaivedWaivedWaivedRequiredRequired
FDA-Approved Rapid HIV TestOraQuick AdvanceUni-Gold RecombigenClearview  Stat-Pak and CompleteReveal G-3Multispot
Specimen NeededOral swab or blood (fingerstick)Whole blood
(fingerstick)
Whole blood
(fingerstick)
Serum
plasma
Serum
plasma
Turnaround Time (minutes)201015310
CLIA* RequirementWaivedWaivedWaivedRequiredRequired

*CLIA (Clinical Laboratory Improvement Amendment) "waived" means testing does not have to be done by certified laboratory staff.

  • Next steps if rapid test positive
    • Confirm reactive tests with Western blot or immunofluorescent assay (IFA).
    • Nonreactive tests with high suspicion for acute HIV infection should be followed up with a virologic test such as HIV RNA assay (viral load).
    • Viral load is very high (>100,000 copies/mL) in acute HIV infection.
    • If virologic test is positive, then repeat antibody testing in 3 months after seroconversion.
  • HIV antibodies - Western blot
    • Test results are positive, negative, or indeterminate. Indeterminate tests result from nonspecific reactions of HIV-negative sera with some HIV proteins.
    • If the test is indeterminate, repeat ELISA test in 1 month.

Procedures

Counseling pre- and post- rapid HIV testing

  • Pre- and post-test counseling can be done by nonmedical personnel.
  • Pre-test counseling can be completed via prerecorded video or pamphlet and takes about 1-20 minutes. 
  • Resources are available for scripting counseling sessions via the CDC website.
  • Post-testing referrals for positive rapid test results need to be prearranged (dedicated follow-up program).

More on HIV, Early Recognition and Rapid Testing

Overview: HIV, Early Recognition and Rapid Testing
Differential Diagnoses & Workup: HIV, Early Recognition and Rapid Testing
Treatment & Medication: HIV, Early Recognition and Rapid Testing
Follow-up: HIV, Early Recognition and Rapid Testing
Multimedia: HIV, Early Recognition and Rapid Testing
References

References

  1. CDC HIV/AIDS Science facts: CDC releases revised HIV testing recommendations in healthcare settings. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/hiv/topics/testing/resources/factsheets/pdf/healthcare.pdf. Accessed December 1, 2008.

  2. Greenwald JL, Burstein GR, Pincus J, Branson B. A rapid review of rapid HIV antibody tests. Curr Infect Dis Rep. Mar 2006;8(2):125-31. [Medline].

  3. HIV infection: detection, counseling, and referral. Sexually transmitted diseases treatment guidelines 2006. National Guideline Clearinghouse. Available at http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=9674&nbr=5183. Accessed March 25, 2009.

  4. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. National Guideline Clearinghouse. Available at http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=9799&nbr=5246. Accessed March 25, 2009.

  5. Centers for Disease Control and Prevention. HIV/AIDS Statistics and Surveillance. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/hiv/topics/surveillance/incidence.htm. Accessed December 3, 2008.

  6. HIV and AIDS estimates and data, 2007 and 2001. 2008 Report on the Global AIDS Epidemic. Available at http://data.unaids.org/pub/GlobalReport/2008/jc1510_2008_global_report_pp211_234_en.pdf. Accessed April 7, 2009.

  7. World Health Organization. Global Summary of the AIDS Epidemic, 2007. Available at http://www.who.int/hiv/data/2008_global_summary_AIDS_ep.png. Accessed April 7, 2009.

  8. Joint United Nations Programme on HIV/AIDS (UNAIDS). 2008 Report on the global AIDS epidemic - Executive summary. Available at http://data.unaids.org/pub/GlobalReport/2008/JC1511_GR08_ExecutiveSummary_en.pdf. Accessed April 7, 2009.

  9. Branson B. Rapid HIV testing: 2005 update. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/hiv/topics/testing/resources/slidesets/pdf/USCA_Branson.pdf. Accessed December 1, 2008.

  10. Department of Health and Human Services. November 3, 2008; 1-139. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. AIDSinfo. Available at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed December 1, 2008, pages 38, 70-72; tables 8,11, appendix B Table 1a.

  11. FDA-approved rapid HIV antibody screening tests. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/hiv/topics/testing/rapid/rt-comparison.htm. Accessed December 1, 2008.

  12. Greene WC. The molecular biology of human immunodeficiency virus type 1 infection. N Engl J Med. Jan 31 1991;324(5):308-17. [Medline].

  13. Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA. Aug 6 2008;300(5):520-9. [Medline].

  14. Kahn JO, Walker BD. Acute human immunodeficiency virus type 1 infection. N Engl J Med. Jul 2 1998;339(1):33-9. [Medline].

  15. Stebbing J, Gazzard B, Douek DC. Where does HIV live?. N Engl J Med. Apr 29 2004;350(18):1872-80. [Medline].

Further Reading

Keywords

HIV infection, HIV, AIDS, rapid testing, rapid HIV testing, HIV treatment, HIV symptoms, HIV causes, STD, sexually transmitted disease, human immunodeficiency virus, acquired immune deficiency syndrome, highly active antiretroviral therapy, HAART, Lentivirus, retroviruses, HIV-related illnesses, Pneumocystis jiroveci pneumonia, P jiroveci pneumonia, PCP, cryptococcal meningitis, tuberculosis, TB, cytomegalovirus retinitis, CMV retinitis, CNS toxoplasmosis, central nervous system toxoplasmosis, toxoplasmosis, HIV-associated malignancies, oral candidiasis, acute retroviral syndrome

Contributor Information and Disclosures

Author

Jeff Dubin, MD, Medical Director, Emergency Department, Washington Hospital Center, Assistant Professor, Department of Emergency Medicine, Georgetown University School of Medicine
Disclosure: Nothing to disclose.

Medical Editor

Ronald A Greenfield, MD, Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine
Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist  Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eric L Weiss, MD, DTM&H, Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine
Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.