In the last 30+ years, there have been significant advances in the field of HIV testing. Improvements in test sensitivity for early or acute HIV infection have occurred largely because test developers have targeted analytes that appear sooner after infection. But there have also been advances in other aspects of the tests, including things like reductions in the time to it takes for tests to produce a result in the laboratory, and tests that can be performed accurately outside of laboratory settings (e.g. in a park, nightclub, or a church). While the performance of individual tests improved incrementally over the last 30 years, from 1989 until 2014 the algorithm for laboratory diagnosis of HIV infection remained largely unchanged. But, since 2014, that guidance has already been updated twice as new data and new tests continue to emerge. However, challenges have also been identified as laboratories try to implement the recommended algorithm. In addition to logistical issues with the algorithm, recent data have documented how PrEP and early treatment initiation have led to new questions for HIV diagnostics. In the face of these challenges, the landscape of available HIV tests continues to expand and improve. Several groups are developing platforms for single use devices that quantify HIV nucleic acid in less than an hour. In fact, similar technologies have already been implemented for other viral diseases. This presentation will review the latest information on HIV test technologies, describe the challenges and opportunities that current and emerging technologies create for HIV testing, and discuss barriers to implementation and new opportunities for HIV prevention and care in the context of this evolving technology.
US Centers for Disease Control and Prevention