HIV Testing: The ELISA (enzyme linked immunosorbet assay) is the most commonly used screening test; it detects serum antibodies directed against HIV, It is an extremely Sensitive test and is capable of detecting HTV antibodies in nearly all HIV infected patients. Although HIV antibodies are usually detectable 9 to 12 weeks after acute infection and persist, antibody response to initial infection may be absent for up to a year or more in a very small proportion of HIV infected individuals. Therefore, high-risk patients with a negative HIV antibody test should be reevaluated after several months.

Although ELISA test sensitivity and specificity are generally high, the most commonly used Western blot, a confirmatory test is required, Positive HIV antibody tests in children up to 18 months of age born to mothers are not necessarily diagnostic of infection, because the antibodies in the child may be due to passive transfer of maternal antibody, In this setting, physical findings are very important.

Polymerase chain reaction (PCR) testing, a gene amplification procedure that facilitates the identification of minute quantities of HIV genetic sequences in blood or other tissues, are potentially useful in early diagnosis and those with atypical Western blots. RECOMMENDATIONS: HIV testing must be confidential, with pre and posttest counseling and with results (positive or negative) provided in person. It is an individual’s right to decline testing. However, individuals at high risk who decline testing to be educated that the more they know about their health status, the greater their ability to make informed decisions. They should be monitored at regular intervals and testing should be encouraged repeatedly.

Counseling: Counseling an individual at risk for HIV infection involves many aspects and should be individualized, HIV infection and AIDS are emotionally loaded subjects, the time between drawing the blood sample and receiving the results is an extremely difficult and anxious time for almost all patients.

Pretest counseling by physicians includes explanation as regards to the test, anonymity, confidentiality and informed consent. Posttest counseling when he or she is given the results of an HIV antibody test is extremely important. The results of HIV testing, whether positive or negative, are communicated in person and not by telephone, the physician is prepared for reactions to diagnosis of HIV infection that are extreme and provide a caring and supportive environment. Risk reducing and risky behaviors such as unprotected sex or shared needles are discussed with the patient, Infection control guidelines are given to them. The women of childbearing age are counseled about the risk of prenatal transmission.

Because of the emotional impact of a diagnosis of HIV infection, follow-up and referrals are required for most individuals who are HIV infected. Ongoing counseling for those who test negative and need assistance in staying uninfected is also very important.

Asymptomatic and mildly symptomatic individuals may not understand that they do not have AIDS at the present time. The CD4 cell count is helpful in explaining the progression of HIV infection; the new concept is “living with H1Y infection” rather than “dying of AIDS.”

Problems of discrimination exist. HIV infected individuals face job loss as well as loss of income, insurance and status. In spite of these problems, HIV infected patients are advised to promptly inform the people whom the diagnosis directly affects their physicians, dentists, sexual partners and others.

A patient can join HIV support group. Community based volunteer groups and programs that offer support and companionship in order to avoid isolation and build a common bond with other individuals have sprung up across the United States. It may be difficult for substance abusers to reshape their risk behaviors because of longstanding addiction.

Patients often perceive HIV infection as a rapidly fatal illness. However, it is important to realize that HIV infection is a chronic medical condition that can be treated but not yet cured. There are effective means of delaying progression to AIDS and of preventing complications.

This information provides a general overview on AIDS and may not apply in each individual case. Consult your physician to determine whether this information can be applied to your personal situation and to obtain additional information.

Article extracted from this publication >>  June 18, 1993