Innovations in HIV Testing Procedures

What is HIV?

HIV is a virus that first made its presence known in the late 1970’s and was a mystery to the medical profession. Many men, mostly homosexually active men, were coming down with all kinds of rare diseases. It seemed to be a kind of rare and extremely aggressive cancer that was, initially, referred to as “Gay Cancer,” later identified as Kaposi’s Sarcoma. After much research, it was determined that the affected men had one thing in common-blood tests revealed they all had HIV antibodies in their blood. Antibodies are formed by the immune system to fight diseases, and each disease has a signature antibody.

Where did HIV come from?

The virus is a common one that is present in the Simian monkey found in Africa. The monkeys have the virus, known as SIV; they do seem to have any adverse reaction to it. Also, there is no conclusive evidence that determines exactly how the virus came to the United States. There are many theories, including bestiality, but the reigning theory now is that Gaetan Dugas, a Canadian flight attendant nicknamed “patient zero,” had sex with an HIV or AIDS infected African man. There is no conclusive proof of this, only that, by his own recollections, he had about 250 different homosexual partners each year. While it may not be clear if Dugas actually brought AIDS to North America, he certainly facilitated its spread. Dugas died in 1984 of AIDS. In the 1990’s, a study of blood taken in the 1950’s showed that the virus was here long before Dugas’ time.
How is HIV contracted?

HIV is a member of the family of virus’ called “lentivirus,” also called a “slow virus” so named because of the long time it takes to have any discernable affect on the body. This family of virus’ affects the body’s immune system and makes it increasingly difficult to fight off diseases. The effect starts slowly. The infected person may find it harder to fight off colds and such. Then, as the virus matures, the person would find that the diseases become more serious and harder to fight off. Most people who contract HIV do so through bodily fluid exchanges. This is generally accomplished in one of two ways: sexual contact where bodily fluids are exchanged, semen or blood, or by needles that are infected with the disease, drug injections or blood transfusions, although the latter is becoming rare as the blood supply is rigorously tested.

What are the testing options?

HIV can produce testable results in as little as three months after exposure. Generally, by the sixth month it will be clear if a person has HIV or not. There are several ways that the testing is done. The Following is a list of tests and some of the more salient points regarding the tests:

ELISA
1. Normally the first test administered
2. Inexpensive and very sensitive
3. Usually blood but also saliva and urine
4. Test results in 3.5-4 hours (generally takes longer since the sample is generally sent to an outside lab. Sometimes one to two weeks)
5. False negatives are very rare
6. False positives are rare

Western Blot (WB) assay
1. Used only to confirm a positive ELISA test result
2. Uses blood sample
3. Results are positive, negative, or indeterminate
4. False positives are extremely rare
5. Indeterminate results need to be re-tested

Indirect Immunofluorescence Assay (IFA)
1. Used only to confirm a positive ELISA test result
2. Used in place of the Western Blot
3. Uses blood sample
4. Faster that the Western Blot

One thing that these tests have in common is the wait involved. Since most testing facilities do no do their own testing, they send the samples out to a laboratory that waits until they have enough for a batch to do the test. This may take a week to two weeks. This is a trying time for the individual to determine whether or not HIV is present. A new and advanced application of technology has made it possible for anyone to determine their HIV status in 20 minutes before they leave the site.
Rapid Testing

Traditional HIV testing had had some problems. Last year, approximately 759,000 (approximately 33%) people tested for HIV failed to return for their test results, and 40,000 new infections are expected this year. There is a new HIV testing device that has been approved by the Food and Drug Administration (FDA) a rapid test, OraQuick�© , developed by OraSure Technologies. According to Orasure, of the 5955 tests done at an STD clinic in Colorado, the delivery of the positive test results to the patients was 100%, up from 66% prior to the use of rapid testing. The main advantage of the rapid test is that the results take only 20 minutes to develop. The test is touted to be 99% accurate and can test for both HIV 1 and HIV 2. The rapid test has some definite benefits over the more traditional means of getting an HIV test: the rapid test can use whole blood from either a finger stick or vein and can use plasma or saliva. Needles and finger sticks are some of the reasons that so many people avoid being tested.

One of the primary advantages of using the rapid test method is that it helps to control the number of people who are involved it the procurement of the test results. Historically, there are all of the people at whatever facility is used for the collection of the sample, all of the people at the laboratory used for the test, and all of the people in-between. With the rapid test, the results are produced on-site, and the knowledge of the results can be controlled and limited to the people directly involved in the patient’s care. Removing the stigma that “everyone will know,” will encourage more people to be tested and to actually receive their positive results.

Conclusion

1. There is a way to know your HIV status now
2. There is a way to avoid being stuck by needles or finger sticks
3. There is a way to control how many people know about your HIV status
4. There is no reason why you shouldn’t get tested right now

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