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Selecting an HIV Test: A Narrative Review for Clinicians and Researchers

Hurt, Christopher B. MD*†; Nelson, Julie A.E. PhD*‡; Hightow-Weidman, Lisa B. MD, MPH*†; Miller, William C. MD, PhD, MPH§

doi: 10.1097/OLQ.0000000000000719
Review

Given the many options available, selecting an HIV test for a particular clinical or research setting can be daunting. Making an informed decision requires an assessment of the likelihood of acute infection in the test population and an understanding of key aspects of the tests themselves. The ability of individual tests to reliably detect HIV infection depends on the target(s) being detected, when they can be expected to be present after infection, and the concentration of stable target in test specimens, all of which are explained by the virologic and serologic events after infection. The purpose of this article is to review the timeline of HIV infection, nomenclature, and characteristics of different tests; compare point-of-care and laboratory-based tests; discuss the impact of different specimens on test performance; and provide practical advice to help clinicians and researchers new to the field select a test that best suits their needs.

This narrative review summarizes current testing technologies and discusses key considerations in selecting appropriate tests for different clinical and research applications.

From the *Institute for Global Health and Infectious Diseases, †Behavior and Technology Lab, and ‡Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC; and §Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH

On the basis of a presentation given by C.B.H. at a joint consultation on “Enhancing the Measurement of HIV Exposure Due to Sexual Behavior” for the National Institute of Mental Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and National Institute of Allergy and Infectious Disease on March 22, 2016.

Conflict of Interest and Sources of Funding: C.B.H. is supported by the National Institute of Mental Health (K23MH099941). J.A.E.N. is supported by the University of North Carolina at Chapel Hill Center for AIDS Research, a National Institutes of Health–funded program (P30AI50410). L.H.W. is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R43HD088319). W.C.M. was supported by the National Institute of Allergy and Infectious Diseases (R01AI114320) and Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD080485). The views expressed do not necessarily reflect those of the National Institutes of Health.

Correspondence: Christopher B. Hurt, MD, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd, CB #7030, Chapel Hill, NC 27599-7030. E-mail: churt@med.unc.edu.

Received for publication April 3, 2017, and accepted July 23, 2017.

© Copyright 2017 American Sexually Transmitted Diseases Association