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Test Results
A person who tests for HIV will receive either a negative,
positive, or indeterminate result. It is important to remember
that a person could test negative for HIV antibodies, but
could be recently infected.
The window period is the time it takes for an HIV-infected
person to develop antibodies to HIV to be detected by the
antibody test. Until the infected person's immune system makes
enough antibodies to be detected, the test will be negative
even though the person is infected with HIV.
Some infected people are able to produce antibodies as early
as 2 weeks after infection. Almost everyone will develop enough
antibodies to be detected by 12 weeks after infection. Unfortunately,
there is no way to know how long each infected person will
take to develop antibodies. However, virtually everyone who
is infected will produce antibodies for detection by 12 weeks.
Therefore, to be sure, people should test 3 months after the
last potential HIV exposure.
Because those who are newly infected have so few antibodies
to fight HIV, the virus can grow and multiply unchecked. During
this time, they can have a large amount of virus in their
blood making them highly infectious for HIV. So, during the
window period, it is possible for an infected person to test
negative, but still be able to infect another person.
Negative Results
If the test result is negative, it means one of two things:
- Either the person is not infected with the virus, or
- The person became infected recently and is in the window
period.
Most people take between 2-12 weeks after becoming infected
to produce enough antibodies to show up on the test. In rare
cases, it may take as long as 6 months.
If a person got infected last night and goes for testing
today, the test will not be able to detect antibodies for
this particular exposure. If a person gets a negative test
result and is concerned about a possible recent infection,
s/he should test again three months from the date of last
possible exposure, and practice safer behaviors until s/he
gets the result of the next test.
A negative test result does NOT mean a person is immune
to HIV. If risky behavior continues, infection may occur.
Positive Test Results
A positive confirmatory test indicates the presence of HIV
antibodies. A positive test result means that:
- A person is infected with HIV;
- They can spread the virus to others through unsafe sexual
practices, sharing contaminated injection equipment and/or
breastfeeding; and
- The person is infected for life.
Indeterminate Test Results
Occasionally, a Western Blot test result will come back with
an "indeterminate" or "inconclusive" test result. If a person
has recently engaged in behaviors that put them at risk for
getting HIV, it could mean that they are newly- infected with
HIV and are developing antibodies. This is called sero-converting.
If sero-conversion is suspected, RNA testing can determine
if the HIV virus is present. If RNA testing is not available,
a second specimen should be gathered and tested with an antibody
test. If sero-converting, this second test could show additional
bands or give a positive result.
Indeterminate test results are not always indicative of sero-conversion.
These results can also be caused by cross reaction with other
proteins from several sources including pregnancy, other autoimmune
diseases, and recent influenza vaccination.
For low risk people when sero-conversion is not suspected,
retesting should be conducted at one month and at three months
from the last possible exposure to verify that they are not
infected. Non-infection is indicated if the subsequent tests
continue to be indeterminate (without additional HIV antibody
protein bands) or are negative.
Indeterminate results for low risk clients are rare. It
is possible for some uninfected people to always test indeterminate
(due to the cross reaction from protein bands from something
other than HIV). Other uninfected people who first test indeterminate
may clear their bodies of those other proteins that are causing
the cross-reaction and in subsequent tests, will test negative.
Still others go back and forth between indeterminate and negative.
Counseling messages should explain that only HIV positive
tests indicate infection with HIV and that some people test
indeterminate because of other (non-HIV) proteins in their
bodies that register on the test. No further testing for other
diseases is indicated.
Advantages of Early Testing for
HIV Infection
The new drug therapies for HIV infection can sustain an infected
person's health for long periods of time. Early detection
allows people with HIV the option to receive medical treatment
sooner, take better care of their immune system, and stay
healthier longer. Additionally, early detection of HIV allows
people to take precautions not to infect others.
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Case Study
#5
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| Mr. J. went to his primary care provider (PCP) with
complaints of a flu-like syndrome. He was assured that
this "bug" was making it's rounds in the community, and
he would probably feel much better in several days. He
was encouraged to go home, rest, take extra fluids, and
take Tylenol as needed for fevers. Five days later he
was still not feeling better. In fact, he noticed that
his lymph nodes were enlarged and his whole body felt
achy. Because it was a weekend he went to the local ED,
hoping to get something that would make him feel better
before returning to work on Monday. In the ED the provider
asked a lot more questions than his usual PCP had asked.
In fact, he was irritated when he was asked about his
sexual history and remarked, "What does that have to do
with my sore throat and swollen glands?" The provider
explained that people who are in the stage of seroconversion
with HIV often come in for medical care with symptoms
similar to the ones he was complaining of. He thought
about a woman he had had sex with on his vacation several
months earlier. They had not planned to be intimate, but
things happened and he hadn't prepared by bringing a condom.
Thinking back, he remembered her as being very attractive
and healthy. Still, he agreed to have the HIV test. Results
of the test were positive. Mr. J. was early in the infection
and his body was responding to invasion of the virus.
An appointment was made for him the following week with
an HIV specialist. The provider also offered to help him
connect with the Department of Health Partner Notification
Program, but he declined saying that he had not been sexually
active since his vacation. The provider stressed the need
to use condoms in the future whenever he planned on sexual
activities. |
HIV Testing and Sexual
Assault
Sexual assault is prevalent in the US. More
than 300,000 women and almost 93,000 men are raped annually
according to the National Violence Against Women Survey (NVAWS).
Sexual assault is commonly seen as a highly underreported
crime. Based on existing crime report data, an estimated 40%
of female rape victims are under 18 and most sexual assault
victims know their assailant. Men are also victims of sexual
assault, however, they are even more less likely to report
being assaulted. Apart from the emotional and physical trauma
that accompanies sexual assault, many victims are concerned
about HIV.
According to CDC, the odds of HIV infection
from a sexual assault in the U.S. are 2 in 1,000. Even though
the risk is low, the fear of HIV adds an additional emotional
burden to many people who have been a victim of sexual assault.
HIV testing can be part of the healing process for the victim.
Most will have negative results and will be relieved, however,
those who test positive also need that information for health
reasons and for criminal court cases.
Testing shortly after the sexual assault will
only show the baseline status of the victim. If the victim
is negative, this first early test will provide proof that
the victim was negative at the time of the assault. This can
be helpful in the rare cases that a victim is infected with
HIV because of the assault and it can be used as evidence
in criminal cases.
In order to verify that the victim was not infected
by the assault it will be necessary to test again after the
window period. If this test is negative, it will indicate
that the individual was uninfected at the time of the assault.
If positive, this test will indicate that the victim was infected
by the assault (if not other behaviors the victim engaged
in could have infected the victim).
In addition to the fear of HIV, there are additional
risks for contracting other STDs, and females can become pregnant.
Emergency contraception is part of the medical treatment for
female rape victims. The emergency contraception hotline number,
1-888-668-2528, should be provided by telephone rape counselors
or other counselors.
Most experts recommend that a sexual assault
victim go directly to the nearest hospital emergency room,
without changing their clothing, bathing or showering first.
Trained staff in the emergency room will counsel the victim,
and may also offer testing or referral for HIV, STDs and pregnancy.
It is common practice for the emergency room physician to
take DNA samples of blood or semen from the vagina, rectum,
etc. which can be used as evidence against the attacker. Some
emergency departments may refer sexual assault survivors to
the local health jurisdiction for HIV testing.
Many people feel that the emergency room setting
is a profoundly unpleasant time to question a sexual assault
victim regarding her/his sexual risks, etc. However, testing
shortly after a sexual assault will provide baseline information
on her/his status for the various infections. This information
can be useful for the victim and healthcare provider, especially
for follow-up care and treatment. Additionally, baseline information
can be used for legal and criminal action against the assailant.
All testing to be used for baseline information and legal
action should be done confidentially.
Continue on to HIV
Prevention
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