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SPECIAL ARTICLES: Guidelines Section

REVISED GUIDELINES FOR HIV COUNSELING, TESTING, AND REFERRAL

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Infectious Diseases in Clinical Practice: January 2002 - Volume 11 - Issue 1 - p 32-33
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REVISED GUIDELINES FOR HIV COUNSELING, TESTING, AND REFERRAL

[CDC MMWR 2001;50 RR-19:1]:

The CDC’s Division of HIV/AIDS Prevention provides this 58 page document concerning HIV counseling, testing and referral. Highlights include the following:

  • Who should be tested? Recommendations for HIV Prevention Counseling, Testing, and Referral:
    1. Clients with increased risk and in settings where those risks are found: MSM, corrections, drug/ alcohol programs, shelters, outreach, STD and TB clinics
    2. Patients from populations with >1% HIV prevalence (hospitals with seroprevalence rates of >1%)
    3. Patients from populations with <1% HIV prevalence if: a) symptoms suggest HIV (FUO, OI without known immunosuppression); b) other diagnoses suggesting HIV (STD etc.); 3) self reported high risk, 4) patient requests test
    4. Selected populations: 1) all pregnant women; 2) persons with occupational exposure; 3) persons with known non-occupational exposure
  • Characteristics of the test:

This section provides a useful summary of various tests that are available for detecting HIV, including the routine serology, rapid test, home collection test, the saliva test and the urine test. All of these are designed to detect HIV-1 except standard serology, which detects HIV-1 and 2. All use the enzyme immunoassay (EIA) for screening and a Western blot (WB) or immunofluorescence assay (IFA) for confirmation. All are considered definitive except the urine-based test, the results of which, if positive, should be confirmed with a blood sample due to reduced specificity of the Western blot on urine. Most of these tests require 1–2 weeks for results. The exception is the rapid test, which requires 10–60 minutes. This test is often preferred when determining the need for post-exposure prophylaxis, for pregnant women who present in labor, or in settings where the return rate for results is low. The only rapid test that is currently available and FDA approved is the SUDS test, which requires an on-site laboratory testing capacity. However, this report anticipates that the FDA will approve rapid tests that “could be classified as CLIA waived to avoid the requirement for on-site laboratory testing,” which means provider-read. These tests show accuracy comparable to standard HIV serology. Details are provided in Table 2.

TABLE 2
TABLE 2:
Tests for HIV Detection

Interpretation of Tests:

  • Positive tests: False positive tests are rare except in cases of laboratory error or mislabeling; patients with positive tests and no identifiable risks should be considered for repeat testing.
  • Negative tests: False negative results can be caused by: 1) Clinical symptoms of acute HIV infection or late AIDS; 2) Infection with HIV-2 or HIV-1 group 0 infection; 3) Recent infection.
  • Indeterminate test results: Recommendations are to repeat testing at least one month later; tests for HIV DNA or RNA are not FDA approved for diagnostic purposes, but may be used in consultation with specialists for determining the infection status of persons with in determinant results.
© 2002 Lippincott Williams & Wilkins, Inc.