Types of HIV Tests

Types of HIV Tests (Which HIV Test is Right for Me)

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Though sev­er­al dif­fer­ent tests exist, there are three main cat­e­gories of HIV test­ing avail­able on the mar­ket today. Every form of test­ing list­ed below will fall under one of these three main categories.

Viral Load: Peo­ple are usu­al­ly refer­ring to HIV or AIDS infec­tion when they talk of viral load’, although it can apply to oth­er infec­tions as well. Basi­cal­ly, viral load’ stands for the amount of virus in the body. 

HIV works by mak­ing more and more copies of itself through­out the body. With­out treat­ment, viral load can become very high (worse for patient). How­ev­er, today’s antivi­ral ther­a­py (treat­ment) will actu­al­ly stop the HIV virus from mak­ing copies at all, thus pre­vent­ing the viral load from increasing.

This is why ear­ly detec­tion is so impor­tant; you want to halt the viral load while it is already very low, and pre­vent it from increas­ing. Though there is no known cure for HIV, prop­er treat­ment can make the viral load so low it is very unlike­ly to infect others.

  • Peo­ple new­ly infect­ed tend to be very infectious. 

Anti­body tests

The human body pro­duces anti­bod­ies (spe­cial­ized pro­teins) in reac­tion to the HIV virus, or anti­gens in gen­er­al. In fact, the body will pro­duce anti­bod­ies in order to help com­bat almost any infec­tion; it is a nat­ur­al defen­sive response. An HIV anti­body test mea­sures the amount of anti­bod­ies present in the body in order to fight the HIV infection. 

Of course, it can take 4 – 6 weeks, even up to three months after infec­tion, for the body to pro­duce enough anti­bod­ies for an accu­rate test result. Though this is con­sid­ered a Rapid Anti­body Test’, the time frame is length­i­er than oth­ers and prob­a­bly not ide­al for those who want the absolute best health care avail­able. After all, the quick­er HIV is detect­ed, the bet­ter the options a patient has.

  • Anti­body tests are the most com­mon tests for HIV.

ELISA (EIA) Test

The enzyme-linked immunosor­bent assay test is one of the more pop­u­lar HIV tests, mea­sur­ing anti­bod­ies in the blood­stream. Requir­ing a blood sam­ple, the test is very sim­ple, rel­a­tive­ly pain­less (minus the slight nee­dle sen­sa­tion of blood being drawn), and involves lab­o­ra­to­ry test­ing. False results are pos­si­ble; your health care provider may order addi­tion­al tests for accuracy.

  • ELISA tests are the main anti­body tests for HIV
  • Rapid test­ing can yield results in 10 – 30 minutes. 
  • Pos­i­tive results don’t nec­es­sar­i­ly mean you are pos­i­tive, but indi­cate you’ll need a sec­ond test for con­fir­ma­tion (West­ern Blot).

West­ern Blot Test

West­ern Blot is fre­quent­ly test­ed as a fol­low up to con­firm the pres­ence of anti­bod­ies. Typ­i­cal­ly, the test is used to con­firm a pos­i­tive HIV diag­no­sis, or a pos­i­tive ELISA.The two tests togeth­er are 99% effective.

RNA (viral load) Tests

Unlike anti­body tests, RNA test­ing is a bit more direct, mea­sur­ing the actu­al pres­ence of virus mate­r­i­al (RNA) in the blood. Though there may be few symp­toms dur­ing these first few days after infec­tion, the virus is con­tin­u­ing to pro­duce more and more of itself. RNA test­ing can track increas­es and decreas­es of HIV viral load in order to eval­u­ate treatment.

  • Viral load tests are usu­al­ly rec­om­mend­ed only in very high risk sit­u­a­tions where infec­tion is like­ly. This is because the test­ing is less accu­rate, more expen­sive, and requires more lab­o­ra­to­ry resources.

Ear­ly Detec­tion HIV RNA Test

HIV RNA test­ing can be tak­en much ear­li­er than the anti­body tests above, before the body even begins to pro­duce anti­bod­ies at all. You’re look­ing at an ear­ly win­dow of 9 – 11 days after expo­sure, com­pared to 4 – 6 weeks with anti­body tests, mak­ing RNA test­ing ide­al for best treat­ment options. In fact, the ear­ly test win­dow is the major advan­tage HIV RNA test­ing has over anti­body testing. 

  • HIV RNA test­ing is the most sen­si­tive, and accu­rate, ear­ly test­ing option for HIV avail­able on the mar­ket today. 
  • Though the test win­dow is much ear­li­er, viral load test­ing is unfor­tu­nate­ly less accu­rate than the two above, false read­ings more com­mon. Sub­se­quent tests are more often request­ed to con­firm readings. 

P24- com­bi­na­tion (anti­body-anti­gen test, or HIV Ab-Ag test)

A major HIV pro­tein, called P24, the anti­gen being test­ed here is pro­duced 2 – 3 weeks after infec­tion bet before anti­bod­ies are pro­duced. Though these do give an ear­li­er result than anti­body tests, they still aren’t rec­om­mend­ed as ear­ly as viral load RNA tests.

  • P24- com­bi­na­tion tests will detect over 95% of infec­tions over 4 weeks of exposure. 
  • These tests can detect the P24 pro­tein an aver­age of 10 – 14 days after infec­tion, although results are less reliable. 
  • The P24 pro­tein is usu­al­ly not detectable after 5 weeks. 

Con­clu­sion: Which HIV Test is Right for Me?

Anti­body Tests

We know anti­body tests can take any­where from one to three months to yield an accu­rate result, but the results are very accu­rate. So, we lose the option for ear­li­est med­ical treat­ment, but can be very reas­sured in the test results. 

The tests them­selves are also cheap­er than ear­ly detec­tion RNA test­ing. On the oth­er hand, what lit­tle mon­ey is saved will almost cer­tain­ly be spent on future med­ical treat­ment- and quite a lot after that. In oth­er words, the cost of these tests are minis­cule com­pared to what you will spend on future med­ical treat­ment if you are in fact HIV pos­i­tive. That being said, costs will like­ly increase the more med­ical care that is need­ed, and the lat­er the virus is caught, the bet­ter odds more treat­ment will be necessary.

Ear­ly Detec­tion HIV RNA Test

These tests are going to be a bit more cost­ly, and ini­tial test­ing is less accu­rate; false pos­i­tives are more com­mon. Of course, false results are easy to iden­ti­fy, pro­vok­ing the option for sub­se­quent test­ing to confirm.

RNA test­ing can iden­ti­fy the virus after just a few days, giv­ing the best pos­si­ble option for treat­ment. This way, patients can start treat­ment when viral load is very low, and keep it very low. The ben­e­fits here far out­weigh any drawbacks.

  • Remem­ber, these tests are often only rec­om­mend­ed in high risk sit­u­a­tions. Oth­er­wise, anti­body test­ing is often giv­en due to the high­er accu­ra­cy of both tests combined.
  • Did you know- it is pos­si­ble, even com­mon, to get HIV viral load lev­els so low, it’s all but impos­si­ble to pass the virus to oth­ers? The only way this can hap­pen is through prop­er med­ical treatment.
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