Rapid Testing for HIV 

Early diagnosis of acute human immunodeficiency virus (HIV) infection by rapid HIV testing can help identify patients who may be candidates for antiretroviral treatment, which has been shown to delay the progression to acquired immunodeficiency syndrome (AIDS) and death.^[1] Rapid HIV testing may also be useful to quickly confirm HIV status in a patient not known to be HIV positive who presents with an AIDS-defining illness.

The Centers for Disease Control and Prevention (CDC) recommends HIV screening of all US residents aged 13-64 years.^[2] This can be completed at any convenient physician encounter, including emergency department visits and even outreach programs utilizing mobile clinic vans to see patients.

Studies have shown that nearly one third of patients screened for HIV by traditional programs with pretest counseling and blood tests that are sent to a central laboratory fail to return for follow-up visits to learn the results.^[3] Rapid HIV testing provides the results during the single counseling session. Identification of asymptomatic HIV-positive patients benefits the individual and the public health. Seropositive patients can be referred for treatment and taught about practices that will help reduce the risk of infecting others.^[4]

For other discussions on HIV infection, see HIV Disease, Pediatric HIV Infection, and Antiretroviral Therapy for HIV Infection, as well as HIV in Pregnancy.

Patient education

Provide frank, complete, nonjudgmental information on the routes of transmission. Teach HIV-infected patients how to minimize the risk to others.

For patient education information, see the Immune System Center, Sexually Transmitted Diseases Center, and Yeast and Fungal Infections Center, as well as HIV/AIDS, Rapid Oral HIV Test, and Candidiasis (Yeast Infection).

For more information, see the CDC guidelines for HIV Infection: detection, counseling, and referral and revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings.^{[5, 6]}

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. Counseling protocols and counselor prompt cards are available on the CDC website. Post-testing referrals for counseling patients with positive rapid test results need to be prearranged (dedicated follow-up program).

If HIV seropositivity is expected, 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 that a confirmatory test is necessary. Patients are expected to be anxious after learning rapid HIV test results.

Patients with a high suspicion for acute HIV infection and a probable false-negative rapid HIV test result should have HIV RNA viral load testing done and should be referred for follow-up HIV ELISA testing. Remember that during acute HIV infection, the antibody test ELISA, will usually be negative.

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

Outreach programs can provide rapid HIV testing in the community. Counseling and testing can be completed anywhere. These programs provide an opportunity to identify high-risk patients who otherwise would not seek outpatient testing.

Emergency department (ED) testing has the following features:

• Routine HIV screening of asymptomatic patients and outpatient referral for confirmatory testing and care (routine opt-out screening of ED patients may result in increased numbers of patients tested and identified as HIV positive compared to physician-directed screening^[7] )
• Identification of acute HIV infection with possible ED diagnosis and/or referral for further diagnostics and treatment
• Confirmation of diagnosis of HIV in patients with AIDS-defining illness, previously not known to be seropositive

HIV-positive patients should be referred for confirmatory testing and further outpatient treatment as needed. If acute HIV infection is suspected, send a specimen for HIV RNA viral load testing or recommend a repeat HIV test in 4-8 weeks.

Do not discharge patients with newly diagnosed HIV infection 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.

The US Food and Drug Administration (FDA) has approved 6 rapid HIV tests (see Table 1, below).^[8] All FDA-approved kits have been shown to perform similarly.^[9] These tests assess for HIV antibodies with an enzyme-linked immunosorbent assay (ELISA). Sensitivity and specificity are greater than 99%. Results are reported as reactive or nonreactive.

Table 1. FDA-Approved Rapid HIV Tests (Open Table in a new window)