eMedicine Specialties > Emergency Medicine > Infectious Diseases

HIV, Early Recognition and Rapid Testing: Follow-up

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

Follow-up

Further Outpatient Care

  • Referral for confirmatory testing and further outpatient treatment as needed for HIV-positive patients

Deterrence/Prevention

  • Transmission of HIV
    • Safe sex practice
    • Abstinence
    • Needle exchange programs
    • Universal precautions
    • Antiretroviral drugs for pregnant HIV patients

Complications

  • False-positive and false-negative tests do occur with rapid testing.
  • Positive predictive value is lower in populations with low HIV prevalence, so there will be relatively more false-positive tests in these groups with very low HIV risk factors.
  • If HIV seropositivity is expected, then patients whose test results are positive with rapid HIV tests should be told they likely have HIV and need further confirmatory testing.
  • If HIV is not likely, a patient with a positive rapid test result should be counseled that he or she may have HIV but as this is not likely from risk factor screening, a confirmatory test is necessary.
  • Patients are expected to be anxious after learning rapid HIV test results.
  • Patients with high suspicion for acute HIV infection and probable false-negative rapid HIV test results should have HIV RNA viral load testing and be referred for follow up HIV ELISA testing. Remember that during acute HIV infection, the antibody test ELISA, will usually be negative.

Prognosis

  • When untreated, HIV infection leads to AIDS with a life expectancy of 2-3 years.
  • In untreated HIV infection, the CD4 counts decline at a rate of 50-80 per year with more rapid decline as counts drop below 200.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Missing HIV diagnosis due to false-negative rapid HIV test result 
    • If acute HIV infection is suspected, send HIV RNA viral load test or recommend repeat HIV test in 4-8 weeks.
    • Screening for HIV should be completed after counseling. Pre-test counseling is simple and can even be completed via video device or brochure.
  • Discharging newly diagnosed HIV patients without proper follow-up for testing or treatment  
    • Make sure follow-up care has been arranged for patients prior to initiating an HIV screening program.

Special Concerns

  • Protect patient confidentiality. Patients may not have informed family members or friends of their risk behaviors or diagnosis.
 


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
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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].

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Further Reading

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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

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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.

 
 
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