AIDS/HIV Detection and Treatment
The only way to know for sure if you have HIV is to get an HIV test.
If you are at risk of HIV, you should have an HIV test every six months. You should also reduce your risk (see the section on Prevention).
Soon after HIV infection, the body begins to make antibodies that fight the virus. The HIV test looks for these antibodies in your blood. After about three months, most people have enough anti-HIV antibodies to test positive on standard HIV tests. Some people don’t test positive for six months or even a year, so repeat testing is needed.
The HIV test is simple. Home tests are available. You can also get tested at labs that keep your identity secret. You can also get tested by your doctor, and at your public health department. If you are doing a home test, or if you order a test from a lab, a positive result means you should see a doctor to confirm that you’re really infected.
If you know you are at high risk of HIV infection and come down with a bad case of the flu, see a doctor right away. It could be the early signs of HIV infection. Tell your doctor about your risk behavior. There are very sensitive tests that can tell if you’ve got HIV - and treatment during this very early stage of infection works best.
Before getting tested, think about what your test result will mean. Most people need help with this, so see a counselor, psychologist, or doctor for advice - or call your local AIDS hotline. Prepare for your result.
If you test negative, you may want to talk about how to reduce your future risk. There are many private AIDS organizations that can give you this kind of help. Usually these organizations have "been-there, done-that" counselors you can relate to.
Should I get tested for HIV?
CDC recommends that health care providers test everyone between the ages of 13 and 64 at least once as part of routine health care. One in seven people in the United States who have HIV do not know they are infected.
Behaviors that put you at risk for HIV include having vaginal or anal sex without a condom or without being on medicines that prevent or treat HIV, or sharing injection drug equipment with someone who has HIV. If you answer yes to any of the following questions, you should definitely get an HIV test:
- Have you had sex with someone who is HIV-positive or whose status you didn’t know since your last HIV test?
- Have you injected drugs (including steroids, hormones, or silicone) and shared equipment (or works, such as needles and syringes) with others?
- Have you exchanged sex for drugs or money?
- Have you been diagnosed with or sought treatment for a sexually transmitted disease, like syphilis?
- Have you been diagnosed with or sought treatment for hepatitis or tuberculosis (TB)?
- Have you had sex with someone who could answer yes to any of the above questions or someone whose history you don’t know?
If you continue having unsafe sex or sharing injection drug equipment, you should get tested at least once a year. Sexually active gay and bisexual men may benefit from more frequent testing (e.g., every 3 to 6 months).
You should also get tested if
- You have been sexually assaulted.
- You are a woman who is planning to get pregnant or who is pregnant.
If you test positive, you’ll need help deciding what to do. HIV infection isn’t a death sentence. It does mean that you will need to take special care of your health. It also means that you will have to take special care not to infect anybody else with the AIDS virus.
If you test positive for HIV, you must have medical care. If you don’t have a doctor, a local AIDS organization or AIDS hotline can help you find one. Get some help from a person you trust. If you don’t have a person like this in your life, get help from a professional counselor. Have this person go with you to the doctor.
If you test positive, you have to tell your sex and/or needle-sharing partners that they, too, need to be tested. But you don’t have to tell everybody else. Tell only those people who can support you. If you have children, talk with a counselor about what to tell them, and when.
What Are the Treatments?
Treatment with combinations of AIDS drugs can keep people with HIV from getting AIDS.
In clinical studies, where everybody gets state-of-the art treatment and very regular medical exams, the drugs work for the vast majority of people. In the real world, some AIDS doctors say, the drugs fail in about half of their patients.
Why? Not all AIDS drugs work for all people. It’s absolutely essential to take the drugs at the right time of day, every single day. Sometimes the drugs’ side effects - or simple human nature - make this very hard to do. And because HIV is constantly mutating, no two people are infected with exactly the same virus.
Treatment must be planned and adjusted for every individual person with HIV. When to start treatment is a big question. Everybody agrees that starting aggressive treatment in the early days after infection - the stage of acute HIV infection - is most effective. But most people don’t find out they have HIV until the stage of chronic HIV infection, when the virus has a firm hold on the body. There’s no hard and fast rule about when to start treatment for such patients.
Most AIDS/HIV doctors now recommend holding off on treatment until a person’s immune system starts to fail. This decision is based on the CD4 T-cell count, the best measure of HIV disease. Another factor is how much HIV is in the blood - a measure called viral load.
When treatment begins, the decision on which anti-HIV drugs to use is crucial. New tests can tell which drugs will work best on the HIV infecting an individual patient.
There are several types of anti-HIV drugs. Because HIV mutates so quickly, it soon is able to resist any single treatment. That’s why doctors use combinations ("cocktails") of anti-HIV drugs. Virus that’s resistant to one drug gets killed by another. Over time, even this strategy isn’t always enough, and virus resistant to multiple drugs may appear. At this point, a doctor will switch to another drug combination. While there are many AIDS drugs, the possibilities are not endless. Researchers are working hard to find new ways to treat patients who have run through several different combination treatments.
The different types of anti-HIV drugs each target a different aspect of HIV’s life cycle:
Entry. HIV has to get into a T cell to start its dirty work. First it has to latch on to the cell. Next it has to fuse its own outer membrane to that of the cell. New drugs called attachment inhibitors and fusion inhibitors are being tested in humans.
Early replication. HIV’s goal is to take over a T cell’s genetic machinery. After fusing with a cell, the virus spills its genetic material into the cell. HIV has a problem here - its genetic code is written in a form called RNA. But in humans, our genetic code is written in DNA. HIV solves this problem by making an enzyme - called reverse transcriptase or RT - that translates its RNA into DNA. The class of AIDS drugs called nucleoside RT inhibitors ("Nukes") fools HIV into making flawed reverse transcriptase out of bogus raw materials. Another class - the non-nucleoside RT inhibitors or Non-Nukes - gums up reverse transcriptase so it doesn’t work. Several Nukes and Non-Nukes are now in use.
Late replication. HIV has to snip apart the cell’s DNA, put its own DNA in, and sew the DNA strand back together. The sewing kit it needs to do this is called integrase. Human tests of an integrase inhibitor began in 2001.
- Assembly. Once HIV has taken over a cell’s genetic material, it gets the cell to make the pieces from which a new virus is made. These pieces have to be cut into the right size - and that’s what HIV’s protease enzyme does. Several protease inhibitors (or PIs) are now on the market.
Another approach is to make the body’s immune system fight HIV more effectively. One way to do this is with a chemical messenger called interleukin-2 or IL-2, now in advanced human tests. Other immune stimulators are in various stages of development.
Yet another strategy is to use antisense drugs. These are strands of genetic material that form a kind of mirror image of HIV’s genetic code. This throws a monkey wrench into the virus’s replication machinery. One antisense drug has entered human tests.
What kinds of tests are available, and how do they work?
The most common HIV test is the antibody screening test (immunoassay), which tests for the antibodies that your body makes against HIV. The immunoassay may be conducted in a lab or as a rapid test at the testing site. It may be performed on blood or oral fluid (not saliva). Because the level of antibody in oral fluid is lower than it is in blood, blood tests tend to find infection sooner after exposure than do oral fluid tests. In addition, most blood-based lab tests find infection sooner after exposure than rapid HIV tests.
Several tests are being used more commonly that can detect both antibodies and antigen (part of the virus itself). These tests can find recent infection earlier than tests that detect only antibodies. These antigen/antibody combination tests can find HIV as soon as 3 weeks after exposure to the virus, but they are only available for testing blood, not oral fluid.
The rapid test is an immunoassay used for screening, and it produces quick results, in 30 minutes or less. Rapid tests use blood or oral fluid to look for antibodies to HIV. If an immunoassay (lab test or rapid test) is conducted during the window period (i.e., the period after exposure but before the test can find antibodies), the test may not find antibodies and may give a false-negative result. All immunoassays that are positive need a follow-up test to confirm the result.
Follow-up diagnostic testing is performed if the first immunoassay result is positive. Follow-up tests include: an antibody differentiation test, which distinguishes HIV-1 from HIV-2; an HIV-1 nucleic acid test, which looks for virus directly, or the Western blot or indirect immunofluorescence assay, which detect antibodies.
Immunoassays 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 is a lab test, and it is positive, the lab will conduct follow-up testing, usually on the same blood specimen as the first test.
Currently there are only two home HIV tests: the Home Access HIV-1 Test System and the OraQuick In-home HIV test. If you buy your home test online make sure the HIV test is FDA-approved.
The Home Access HIV-1 Test System is a home collection kit, which involves pricking your finger to collect a blood sample, sending the sample to a licensed laboratory, and then calling in for results as early as the next business day. This test is anonymous. If the test is positive, a follow-up test is performed right away, and the results include the follow-up test. The manufacturer provides confidential counseling and referral to treatment. The tests conducted on the blood sample collected at home find infection later after infection than most lab-based tests using blood from a vein, but earlier than tests conducted with oral fluid.
The OraQuick In-Home HIV Test provides rapid results in the home. The testing procedure involves swabbing your mouth for an oral fluid sample and using a kit to test it. Results are available in 20 minutes. If you test positive, you will need a follow-up test. The manufacturer provides confidential counseling and referral to follow-up testing sites. Because the level of antibody in oral fluid is lower than it is in blood, oral fluid tests find infection later after exposure than do blood tests. Up to 1 in 12 people may test false-negative with this test.
RNA tests detect the virus directly (instead of the antibodies to HIV) and thus can detect HIV at about 10 days after infection—as soon as it appears in the bloodstream, before antibodies develop. These tests cost more than antibody tests and are generally not used as a screening test, although your doctor may order one as a follow-up test, after a positive antibody test, or as part of a clinical workup.
Side effects are common with all of these medications. These can include:
- Nausea and vomiting. These side effects are most common in the first weeks or months of anti-HIV treatment. Often they go away as the body gets used to the drugs.
- Diarrhea. Most common early in treatment. Call your doctor if diarrhea lasts for more than three days.
- Rash. Rash is common among people who start taking anti-HIV drugs. Usually it goes away by itself. IMPORTANT: Rash could be a sign of an allergic reaction to a drug. This happens more often to patients taking Ziagen, but also happens to a few patients taking Viramune, Rescriptor, or Sustiva. If you get a rash after taking these drugs, call your doctor right away.
- Problems falling asleep or staying asleep.
- Dry skin and/or ingrown toenails sometimes happen with Crixivan.
- Pain, numbness, tingling, and or burning in the hands and/or feet.
- Kidney stones sometimes occur in people who take Crixivan.
- Changes in the way your body deals with fat. This is called lipodystrophy syndrome. It includes a range of symptoms including a roll of fat between the shoulders ("buffalo hump"); enlarged breasts; and loss of fat in the face, arms, and legs.
Source: Your Health Encyclopedia, 4-rd Edition, 2002