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HIV, Early Recognition and Rapid Testing: Differential Diagnoses & Workup
Updated: Apr 7, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
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.
Open table in new window
Table
| FDA-Approved Rapid HIV Test | OraQuick Advance | Uni-Gold Recombigen | Clearview Stat-Pak and Complete | Reveal G-3 | Multispot |
| Specimen Needed | Oral swab or blood (fingerstick) | Whole blood (fingerstick) | Whole blood (fingerstick) | Serum plasma | Serum plasma |
| Turnaround Time (minutes) | 20 | 10 | 15 | 3 | 10 |
| CLIA* Requirement | Waived | Waived | Waived | Required | Required |
| FDA-Approved Rapid HIV Test | OraQuick Advance | Uni-Gold Recombigen | Clearview Stat-Pak and Complete | Reveal G-3 | Multispot |
| Specimen Needed | Oral swab or blood (fingerstick) | Whole blood (fingerstick) | Whole blood (fingerstick) | Serum plasma | Serum plasma |
| Turnaround Time (minutes) | 20 | 10 | 15 | 3 | 10 |
| CLIA* Requirement | Waived | Waived | Waived | Required | Required |
*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).
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| 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 |
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References
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.
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].
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.
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.
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.
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.
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.
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.
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.
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.
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.
Greene WC. The molecular biology of human immunodeficiency virus type 1 infection. N Engl J Med. Jan 31 1991;324(5):308-17. [Medline].
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].
Kahn JO, Walker BD. Acute human immunodeficiency virus type 1 infection. N Engl J Med. Jul 2 1998;339(1):33-9. [Medline].
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
Differential Diagnoses & Workup: HIV, Early Recognition and Rapid Testing