Evidence + Why Test


 
 
Internal Banner 2.jpg
 
Two professionals working together in meeting.
 

There are 1.1 million US citizens living with HIV and only one in seven are aware of their HIV status.

This means that unless the symptoms emerge, very few people test for HIV. This is due to HIV unawareness, lack of access to test kits, stigma and negligence by healthcare professionals who don’t test for HIV as a routine care test.

Even though effective treatment for HIV has been available in the US since the mid-1990s and has led to a considerable reduction in the numbers of HIV-related deaths, many people are still at a risk of contracting the virus.

Today many people living with HIV in the US consider it a chronic condition rather than an inevitable fatal illness. However, if the estimations by CDC are to go by, only one in seven of the people living with HIV are aware of their HIV status. This results in late diagnosis and continued transmission. These statistics show that the United States should do more to encourage individuals to take HIV tests especially people who have been exposed to HIV infections. HIV testing is a vital step towards HIV and AIDS prevention and treatment.

 
 

Evidence

+ What statistics say

In the United States, an estimated 1,148,200 persons aged 13 and older were living with HIV infection at the end of 2009, including 207,600 (18.1%) persons whose infections had not been diagnosed.

Today, approximately 1.1 million people in the United States are living with HIV, including some 162,500 people who are unaware of their HIV status.

People who are living with undiagnosed HIV transmit roughly 40% of new HIV infections. For these people living with undiagnosed HIV, testing is the first and key step toward maintaining a healthy life and reducing the spread of HIV.

CDC estimates that approximately 50,000 people are infected with HIV each year.

In September 2006, CDC released its Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. They recommend routine HIV screening of adults, adolescents, and pregnant women in health care settings in the United States, as well as reducing barriers to HIV testing.

HIV testing is entering a new era in the United States as lawmakers, health care and insurance executives, and public health officials are making changes in their respective fields to ensure that more people get to know their HIV status – an important consideration for maintaining good health and controlling the spread of the virus.

+ Why HIV testing should be a national priority

The number of people infected with HIV continues to rise in the United States with late diagnosis remaining a major problem. CDC estimates that 21% of current HIV infections in the US are undiagnosed.

Effective treatment for HIV has been available in the country since the mid-1990s, and has led to a significant reduction in the incidence of AIDS and HIV-related deaths. Persons who receive late diagnosis of HIV infections remain at a higher risk of short-term mortality compared to those who get their diagnosis earlier on.

Today many people are living with HIV as a chronic condition rather than an inevitable fatal illness. Of the 1.1 million people presently living with HIV in the US however, it is estimated that at least one in five are unaware of their status – resulting in late diagnosis and continued transmission.

In more recent years, HIV has become less of a priority in many states and localities, leading to reduced funding for HIV related programs. The availability of confidential HIV testing has also been reduced in some instances.

If the availability of free and confidential testing services for HIV is reduced over the long run, cases of late diagnosis and onward transmission of the virus may escalate.

HIV testing programs require funding and support from both the private and public sectors in order to achieve impact.

How civic and community leadership can help

  • Motivate and support policy makers at all levels
  • Provide incentives for widening the reach of voluntary and confidential HIV testing programs and ensure they are appropriately targeted
  • Overcome structural and attitudinal barriers

HIV testing and treatment guidelines and recommendations

There are various tests available for detecting HIV that are generally very accurate. Though no test will detect HIV immediately after infection, some tests detect the virus sooner than others.

There are three different types of HIV diagnostic tests available: antibody tests, antigen/antibody tests, and nucleic acid tests (NAT).

  1. Antibody screening tests. These are tests that detect the presence of antibodies (proteins that a person’s body produces as an immune response to an HIV infection), and not the HIV itself. These antibody tests are the most common and may be conducted in a laboratory or as a rapid test at a testing site. These tests may be performed on blood or oral fluid (not saliva).
  2. Antigen/antibody tests. Also called 4th generation tests, these are tests that look for both HIV antigens and antibodies. They are more recent and more effective in early detection of HIV infection – finding both antibodies and antigens, which are actually pieces of the virus itself. Antigen/antibody tests can detect an HIV infection much earlier than the pure antibody tests because they do not have to wait for the body to make an immune response to the virus. If you’re infected with HIV, an antigen called p24 is produced even before antibodies develop. Tests that detect both antigen and antibodies are now common in the United States and are recommended for testing done in labs. Rapid antigen/antibody tests are also currently available in the country.
  3. Nucleic Acid Tests (NATs). These are tests that look for the actual virus in the blood. These test are typically quite expensive and not routinely used for HIV screening, unless the person recently had a high-risk exposure or a possible exposure with early symptoms of HIV infection.

+ Initial HIV test

An initial test for HIV is usually an antibody screening test or an antigen/antibody test. If a rapid initial HIV test is positive, the individual will usually be sent to a health care provider to get follow-up testing.

If the initial HIV test is a lab test and is positive, the laboratory will usually carry out a follow-up testing on the same blood sample as the initial test. Even though HIV tests are generally very accurate, follow-up testing is important as it allows the health care provider to ascertain that the diagnosis is right.

Additionally, although oral fluids are an alternative specimen for HIV testing, blood tests are usually preferred since they can detect HIV infection sooner after exposure than oral fluid tests. This is because antibody levels are higher in blood than in oral fluid. Newer blood tests can find HIV as soon as 3 weeks after exposure to the virus.

+ Follow-up diagnostic testing

This is performed if the first test result is positive, and is intended to allow you

+ HIV testing and treatment guidelines and recommendations

The most common HIV test is the antibody screening test, which tests for the antibodies that your body makes against HIV, not HIV itself. Antibody tests may be conducted in a lab or as a rapid test at the testing site. They may be performed on blood or oral fluid (not saliva).

Blood tests can detect HIV infection sooner after exposure than oral fluid tests because the level of antibody in blood is higher than it is in oral fluid. In addition, most blood-based lab tests find infection sooner after exposure than rapid HIV tests. Newer blood tests can find HIV as soon as 3 weeks after exposure to the virus.

In addition to antibody tests, there are several tests now in use that can detect both antibodies and antigens, which are pieces of the virus itself. Because these tests do not have to wait for the body to make an immune response to the virus, they can find infection earlier than tests that only look for antibodies.

Follow-up diagnostic testing is performed if the first test result is positive. HIV tests are generally very accurate, but follow-up testing allows you and your health care provider to be sure the diagnosis is right. If your first test is a rapid test, and it is positive, you will be directed to a medical setting to get follow-up testing. If your first test that required a lab for analysis is positive, the lab will conduct follow-up testing, usually on the same blood specimen as the first test.

Follow-up tests include:

  • an antibody differentiation test, which distinguishes HIV-1 from HIV-2;
  • a Western blot or indirect immunofluorescence assay, which detect antibodies
  • an HIV-1 nucleic acid test, which looks for virus directly.

If you would like to learn more about HIV tests that are FDA-approved for use in the United States please go to US HIV tests and Algorithms.

CDC is drafting revised laboratory HIV diagnostic guidelines due to evidence that many persons infected with HIV at the time of testing are not detected by current testing strategies.

The proposed testing process recommends are:

  • Initial screening with a sensitive HIV antigen/antibody test.
  • If reactive, the initial test is followed by a differentiation test that distinguishes HIV-1 from HIV-2.
  • If the differentiation test is negative or indeterminate, HIV-1 nucleic acid testing, which looks specifically for components of HIV, is performed to identify new infections.

Guidelines have been developed and published on HIV testing which set out why and how HIV testing should take place in the US: CDC NPIN - HIV/AIDS CDC HIV/AIDS Guidelines. The guidelines also include data and evidence to support the need for HIV testing and treatment.

+ Evaluating local HIV testing initiatives

If you need guidance on how to assess and implement HIV testing initiatives at a local level, you can refer to the Centers for Disease Control and Prevention 2009, Quality Assurance Standards for HIV Counseling, Testing, and Referral Data. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2009.

You may also be interested in the resources available on the Centers for Disease Control and Prevention (CDC) website; AIDSVu website and AIDS.GOV.

+ Rationale and Evidence: a summary to support free, confidential and voluntary HIV testing

Getting an HIV test is the only way to know if you have HIV. This section answers some of the most common questions related to HIV testing, including the types of tests available, where to get one, and what to expect when you go to get tested. At the end of 2009, an estimated 1,148,200 persons aged 13 and older were living with HIV infection in the United States, including 207,600 (18.1%) persons whose infections had not been diagnosed. CDC estimates that approximately 50,000 people are infected with HIV each year.

HIV testing is entering a new era in this country as lawmakers, health care and insurance executives, and public health officials are making changes in their respective fields to ensure that more people will know their HIV status – an important consideration for maintaining health and reducing the spread of the virus. In September 2006, CDC released Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. These Recommendations advise routine HIV screening of adults, adolescents, and pregnant women in health care settings in the United States. They also recommend reducing barriers to HIV testing. People who are infected with HIV but not aware of it are not able to take advantage of the therapies that can keep them healthy and extend their lives, nor do they have the knowledge to protect their sex or drug-use partners from becoming infected. Knowing whether one is positive or negative for HIV confers great benefits in healthy decision making. Cohort studies have demonstrated that many infected persons decrease behaviors that help transmit infection to sex or needle-sharing partners once they are aware of their positive HIV status (3-10). HIV-infected persons who are unaware of their infection do not reduce risk behaviors (11,12,13). Persons tested for HIV who do not return for test results might even increase their risk for transmitting HIV to partners (14). Because medical treatment that lowers HIV viral load might also reduce risk for transmission to others (15), early referral to medical care could prevent HIV transmission in communities while reducing a person's risk for HIV-related illness and death.

+ Latest evidence on HIV testing and late HIV diagnosis

The number of people infected with HIV continues to rise in the US and late diagnosis remains a major problem.

Effective treatment for HIV has been available in the US since the mid-1990s and has led to a dramatic reduction in the incidence of AIDS events and HIV-related deaths. Many people are now living with HIV as a chronic condition rather than an inevitable fatal illness. However, of the 1.1 million people living with HIV in the US, it is estimated that at least one in five are unaware of their HIV status – resulting in late diagnosis and continued transmission.

In more recent years, HIV has become less of a priority in many states and localities – in some instances funding has been reduced and the availability of confidential HIV testing has been reduces.. If the availability of free and confidential HIV testing services is reduced over the long term, it may result in an increase in late diagnosis and onward transmission.

HIV testing programs require public and private sector support and funding in order to achieve impact. Civic and community leadership is needed to:

  • Motivate and support policy makers at all levels
  • Provide incentives for widening the reach of voluntary and confidential testing programs and ensure they are appropriately targeted
  • Overcome structural and attitudinal barriers

This website presents the evidence to support the benefits of scaling up access to and availability of HIV testing in order to support the rationale for why HIV testing should be a priority.

Note: For the latest evidence on HIV testing and late HIV diagnosis visit the CDC.

 
 

Why Test

Many HIV testing tools such as the Determine ™ by Abbott Pharmaceuticals provide preliminary HIV results within minutes, and many are available at your local community-based HIV organization many times free of charge. Knowing your HIV status and discussing treatment options with your doctor, increases your chances of reducing the viral load in your system and becoming undetectable and unable to transmit HIV to sexual partners (according to the CDC).

+ HIV – the basics

HIV stands for human immunodeficiency virus. It weakens a person’s immune system by destroying important cells that fight disease and infection. No effective cure exists for HIV. But with proper medical care, HIV can be controlled. Some groups of people in the United States are more likely to get HIV than others because of many factors, including their sex partners, their risk behaviors, and where they live. To get more information about HIV, how it’s transmitted, how you can prevent it, and how to get tested for HIV, visit https://www.cdc.gov/hiv/basics/index.html.

+ About PrEP

Pre-exposure prophylaxis (or PrEP) is a powerful HIV prevention tool for people at high risk for HIV. PrEP, a daily HIV medication, can be used to lower their chances of getting infected. It is highly effective for preventing HIV if used as prescribed, but it is much less effective when not taken consistently.

Daily PrEP reduces the risk of getting HIV from sex by more than 90%. Among people who inject drugs, it reduces the risk by more than 70%. Your risk of getting HIV from sex can be even lower if you combine PrEP with condoms and other prevention methods.

For more information visit: https://www.cdc.gov/actagainstaids/basics/prep.html.

+ Youth and HIV

In 2016, youth aged 13 to 24 accounted for 21% of all new HIV diagnoses in the United States. Most of those new diagnoses among youth (81%) occurred among gay and bisexual males. Young black/African American and Hispanic/Latino gay and bisexual males are especially affected. African American gay/bisexual men account for 54% and Hispanic/Latinx gay men account for 25% of new infections among gay men.

Youth with HIV are the least likely out of any age group to be linked to care and have a suppressed viral load achieving undetectable status. That is, having a very low level of the virus in the body, which helps the person stay healthy and greatly reduces the risk of transmitting HIV to others. Addressing HIV in youth requires that we give young people the information and tools they need to reduce their risk, make healthy decisions, and get treatment and care if needed.

Please visit https://www.cdc.gov/hiv/group/age/youth/index.html for more information on HIV among youth.

+ The benefits of early HIV Detection

HIV-positive people that are aware of their status, can receive HIV treatment if needed and remain healthy for many years. It is known that if you are HIV-positive and begin talking to your doctor, you have a greater chance of reducing HIV-related illnesses and can lower the risk of transmitting HIV to others. HIV-positive people that can achieve an undetectable viral load have effectively no risk of sexually transmitting HIV to an HIV-negative partner.

+ About HIV tests

  • The tests used today can usually tell if a person has HIV within a month of their infection. In the past you might have had to wait three months to be certain that your test result is accurate.
  • The most common form of HIV test is a blood test – a small amount of blood is taken and examined.
  • In some areas, oral fluid tests are available. In this test, a sample of saliva is taken using a mouth swab. In others, dried blood spot tests are available, in which the finger or heel is pricked and a spot of blood is blotted onto filter paper for testing.
  • Before someone is given a positive result the blood is tested more times to be completely sure.
  • If you test positive for HIV, you will undergo a number of tests to monitor the progress of the infection to work out when HIV treatment should be started.
  • The sooner you get tested, the sooner you can start life-saving treatment and diminish the risk of transmitting the virus to someone else.
  • Delaying testing and access to treatment will allow the virus to spread in your body and damage your health.

+ Where to get tested

Depending on what state you live in, there are various places to go for an HIV blood test in the United States, including:

  • Sexual and reproductive health centers and STD clinics
  • Hospitals, outpatient clinics and Infectious Diseases Departments
  • Clinics or testing sites run by community based HIV organizations
  • Private doctors and their clinics

    To find a testing center near you visit the maps on AIDSVU.

+ When and how to offer an HIV test – information for healthcare professionals

CDC has developed a number of guidelines that should guide you when offering HIV testing. HIV testing should be offered in a broader range of settings than is currently the case.

  • When people are tested for or diagnosed with other sexually transmitted infections, hepatitis C and tuberculosis, they also need to be offered an HIV test.
  • It should be common practice that all patients presenting signs and symptoms that could be related to HIV infection or with specific indicator conditions related to HIV are offered an HIV test.
  • HIV testing should be routinely recommended to individuals who may have been exposed to HIV.
  • Do not be afraid to talk about HIV, offer an HIV test in the same way you would other routine tests as research shows that most people accept an HIV test when offered.
  • HIV tests should be voluntary and offered in an appropriate setting, protecting the individual’s rights to privacy and confidentiality.
  • A positive HIV test result should always mean that your patient is linked to appropriate care and treatment.

+ I've been diagnosed with HIV – what do I do?

If you’ve just been diagnosed with HIV, many questions and emotions may arise. But you are not alone, community and patient organizations across the United States offer support to people who are living with HIV. Visit the AIDSVu website to get answers to some of these questions and to find organizations near you.

Some test sites directly link all persons who test positive for HIV to appropriate care. If you haven’t already been referred to follow-up care, it is imperative that you seek treatment and care. Visit the HIV/AIDS Bureau website at the Health Resources and Services Administration for more information at www.hab.hrsa.gov for medical providers and treatment access.

For more information about HIV, visit HIV.GOV website and the US Centers for Disease Control and Prevention website, CDC.GOV.