World AIDS Day: New Developments in Testing

The fight against HIV/AIDS is an ongoing battle. About 1.5 million Americans are living with the disease, according to the latest 2017 figures from CDC. Worldwide, that number balloons to 36.9 million.

Approximately 15 percent of people don’t even know they have HIV. This lack of knowledge is what plays a role in spreading HIV, with more than 40,000 new infections per year. The FDA says HIV testing is the most crucial step to combat HIV/AIDS. More testing, and more diagnoses, can help limit the risk of HIV in others.

In conjunction with World AIDS Day, which takes place Dec. 1, we’re looking at the different types of tests offered and when you should get screened.

HIV/AIDS in Oklahoma

HIV diagnoses are most prevalent in the southern states. The CDC reported 52 percent of new diagnoses in 2017 happened in the South.

Oklahoma has 7,000 people living with HIV, according to recent reports. Further data shows about 1,450 Oklahomans have died from HIV/AIDS since the late 1990s.

Oklahoma is one of seven rural states with high HIV transmission rates. As of 2015, Oklahoma had 319 new HIV diagnosis, ranking 27th among states. Figures from 2016 show 82 percent of new diagnoses were male. Of those, 65 percent were age 20 to 39.

The director of the CDC, Dr. Robert Redfield, visited Oklahoma City earlier this year to discuss a $291 million federal plan to address HIV/AIDS in rural states, including Oklahoma. The goal is to reduce HIV infections nationally by 75 percent in the next five to seven years and 90 percent within the next 10 years.

Strides Made in HIV Detection

Since HIV/AIDS became an epidemic the 1980s, the FDA has endorsed various ways to be proactive with early detection. The FDA has approved 12 lab-based tests, eight point-of-care tests, and six supplement tests.

Proper testing and proactive measures can help with early detection. The earlier the better with an HIV diagnosis, since strides in modern medicine have helped create ways to prolong a patient’s life for many years.

The Home Access HIV-1 Test System and the OraQuick Home HIV Test are two examples from the past decade that have helped promote testing. As opposed to scheduling an appointment with a doctor and having to wait for a result, the tests are quick, easy, and offer privacy to the taker.

The Home Access allows you to prick your finger and send it to a lab for testing. The OraQuick test is a rapid test where you swab your gum, place it into a test tube, and wait 20 minutes for a result.

For the future, the FDA is working to decipher the difference in HIV-1 and HIV-2 antibodies when testing. This would help detect traces of HIV in infants who are born with the disease. Currently, antibody tests can’t separate infant and maternal antibodies.

If you test positive, the goal is to delay the HIV progression for as long as possible before it turns into AIDS, in which the stage of HIV infection is the most severe and patients deal with unstable and damaged immune systems that lead to fatal illnesses.

Types of HIV Tests

Testing for HIV isn’t as simple as the blood work you receive at an annual physical exam. Your typical labs or metabolic panels won’t include it. You’ll need a separate test.

Here’s a rundown of the three HIV tests available using blood or oral fluid. How soon each test can detect HIV infection differs, because each test has a different window period. The window period is the time between when a person may have been exposed to HIV and when a test can accurately detect HIV infection.

Nucleic acid tests — This test searches for the actual HIV virus in your blood. Doctors use this test for patients who recently had a high-risk exposure, as it’s the quickest way to find HIV traces (7 to 28 days after an incident). The downside is it’s expensive.

Antigen/antibody combination tests — These tests search for both HIV antibodies and HIV antigens (a part of the virus) in blood.

Antibodies are produced by your immune system when you’re exposed to bacteria or viruses like HIV. Antigens are foreign substances that cause your immune system to activate. If you have HIV, an antigen called p24 is produced even before antibodies develop.

Antigen/antibody tests are recommended for testing done in labs and are common in the U.S. Most people will make enough antigens and antibodies for combination tests to accurately detect infection 13 to 42 days after infection.

Antibody tests — These types of tests are most commonly used in rapid tests and home testing kits.

Antibodies are produced by your immune system when you’re exposed to viruses like HIV or bacteria. HIV antibody tests look for these antibodies to HIV in your blood or oral fluid. It takes time for the body to produce enough antibodies for an HIV test to show that a person has HIV.

The soonest an antibody test will detect infection is three weeks. Most people will develop detectable antibodies within 21 to 84 days after infection. If you have any type of antibody test and have a positive result, you will need to take a follow-up test to confirm your result.

Testing at Home

The FDA approved the first rapid oral HIV home test in 2012. This was a major step in both addressing undiagnosed HIV and the privacy stigma associated with it. Rapid tests need 30 minutes or less to produce a positive or negative result.

Oral fluid self-tests provide an answer in 20 minutes, although it’s possible to receive a false positive test when swabbing (1 in 12 do).

With other home collection kits, you prick your finger and send a blood sample to a laboratory. You then call in a few days to learn your results. The test is confidential to eliminate any privacy concerns.

A positive test with a rapid or home kit requires further testing to confirm the diagnosis. If you test positive for HIV, doctors use two tests, CD4 Count and Viral Load Test, to determine the damage, if any, to your immune system and how much of the virus is present in your body.

A negative test doesn't always mean you aren’t exposed to HIV. Each test has a different window until it can trigger a positive test.

When Should You Take an HIV Test?

The CDC recommends at least one HIV screening for adults. More routine tests are encouraged for people with heightened risks, like injected drug use, having sex (especially unprotected) with multiple partners, sexually active bisexual and gay men, anyone with sexually transmitted diseases, hepatitis, tuberculosis, or if you are a victim of a sexual assault.

Pregnant women should take a test, too. If you’re unaware you have HIV during a pregnancy, you run the risk of passing it on to your child before or during birth or while breastfeeding.

If you’re interested in donating blood or wish to be an organ donor, you’ll need HIV screening. Likewise, military applicants and personnel and prison inmates are subject to HIV tests.

Your health insurance most likely covers HIV screenings for free without a copay. The OKC-County Health Department offers free sexual health screenings, which includes HIV testing.

In general, health providers will prick your finger to take a small sample of blood and run it through testing. You can find a location near you using this search feature from the CDC.