The HIV epidemic continues to be a major global health threat. A report by the World Health Organization (WHO) showed that by the end of 2014, a total of 36.9 million people around the world were living with the HIV infection. That same year, the organization recorded a total of 1.2 million deaths from the AIDS virus. Since the onset of the epidemic, almost 71 million people have been infected worldwide, accounting for about 34 million deaths, according to this article.
In the United States, the Centers for Disease Control and Prevention (CDC) reported that by the end of 2012, an estimated 1.2 million people of ages 13 and older were living with HIV. Of these, 12.8% were unaware of their condition. There are about 50,000 new HIV cases in the country per year, CDC said.
The world of medical science still has to find a cure for the disease that continues to affect and threaten the lives of a substantial number of people. Through the years, various health agencies and communities have exerted significant efforts to combat the epidemic. Emphasis is placed on prevention, early detection, and immediate treatment. Though the end of the search for the ultimate antidote is not yet in sight, advances in therapies including contemporary antiretroviral drugs have shown to be effective in increasing life expectancy among HIV patients. Next to prevention, the key is early detection.
Types of HIV Tests
HIV tests are used to determine whether a person is infected with the Human Immunodeficiency Virus (HIV) which triggers a more deadly disease called Acquired Immunodeficiency Syndrome (AIDS). These tests detect the presence of certain antibodies, antigens, or RNA in a person’s blood, saliva, or urine which signifies that the individual has been infected by the virus.
The tests are available in physician’s offices, clinics, hospitals, health centers, and health departments. Standard tests are either inexpensive or completely free. Testing centers implement a strict confidentiality policy for the protection of the patients. Anonymous testing is also available in most states.
The available types of HIV tests include the following:
These are the most common forms of HIV testing. These tests are done to detect the presence of antibodies to the virus in the person’s blood. Some tests can also detect these biomolecules in the saliva. With a normal antibody test, a patient waits for a few days to a few weeks before he gets a result. A rapid antibody test, however, can give the patient the results between 20 to 30 minutes.
There are two general types of antibody tests that are commonly used:
Enzyme-Linked Immunosorbent Assay (ELISA)
This is usually the first test conducted to determine the presence of antibodies to HIV. If such antibodies are detected in the blood, the test returns an HIV Positive result. It is usually repeated for the confirmation of the diagnosis. When the initial ELISA test returns an HIV Negative result, no further tests need be conducted.
This is performed when two ELISA tests return a positive result. This test is necessary to confirm the diagnosis. It is more difficult and takes longer to perform. Hence, it is also more expensive.
Both tests are highly accurate and when the combination shows positive results, a patient is clinically diagnosed to be HIV positive.
However, the antibody tests cannot successfully detect HIV immediately after exposure because it takes between 2 weeks and 6 months for antibodies to appear in the blood. This is called the “window period” within which a person may be infected and still may not test positive for the virus.
Ideally, antibody tests should be conducted beyond the window period. It is recommended that testing is done at 6 weeks, 3 months, and 6 months after exposure or contact with a person who is HIV infected, as reported in this article.
Here are some other tests that may be used to check for HIV:
Antibody / Antigen Tests
These are tests that can detect the presence of both antibodies to the virus and antigens or particles of the virus itself. Antigens of HIV typically show up within 2 to 4 weeks after infection. Thus, antigen/antibody combination tests can detect HIV much earlier than the standard antibody tests. These screening methods are available only for blood testing. A rapid antibody/antigen test can deliver results within as quickly as 20 minutes.
Polymerase Chain Reaction
The PCR test can identify the presence of the virus itself in a person’s blood. It checks to find genetic material of the virus (RNA or DNA) in the person’s white blood cells. PCR testing requires highly technical skills and costly laboratory equipment. Thus, it is not as common as antibody testing. Not all hospitals and clinics offer this service.
PCR can detect the virus within days or weeks after exposure. It is recommended to be performed when the results of antibody tests are uncertain such as when they were done within the window period. The test is also conducted for the screening of organs and blood intended for donation. In addition, it is done to determine if a baby born to an HIV-positive mother has likewise been infected.
In-Home Test Kits
Home test kits can screen either the blood or saliva for the presence of HIV antibodies. There are two tests currently approved by the US Food and Drug Administration.
Some home testing kits are conducted by pricking the finger, placing drops of blood on the given card, and mailing the card to a licensed laboratory. The sample will be tested using the ELISA and Western Blot methods. The screening is done anonymously and the patient is given an identification number to be used when he claims results by phone call within three business days.
Meanwhile, others can detect antibodies in the saliva. To perform the test, the user swabs his upper and lower gums and places the collected sample in the given vial. This is sent to a laboratory for screening. Results can be expected within 20 to 40 minutes, but a follow-up test should be done if the initial results are positive.
Benefits of Early Detection
CDC recommends that all persons of 13 years of age and older must be tested for HIV, regardless of risk factors, based on the agency’s report. It is also advised that routine screening for adults, adolescents, and pregnant women be conducted in healthcare settings in the United States, according to this informational article.
Persons exposed to risk factors such as those having multiple sex partners, engaging in unprotected sex with a possibly HIV infected person, engaging in risky sexual behavior such as men having sex with men (MSM), and sharing needles for intravenous drug use should get themselves tested right after the lapse of the window period.
It is important to confirm a possible diagnosis as soon as possible for several reasons:
- To avoid transmitting the virus to others, including to other sexual partners or to an unborn child;
- To reduce the viral load in the blood;
- To get immediate treatment.
The earlier the virus is detected, the sooner can treatment and monitoring can begin. Treating the condition in the early stages can significantly slow down the growth rate of the virus. This increases life expectancy and delays the onset of AIDS.
Over the years, newer HIV treatment options have developed including advanced anti-retroviral medication which has shown to greatly increase a patient’s life expectancy.
Untreated, the HIV virus will spread rapidly and the illness will progress to AIDS, the most advanced stage. When the immune system is considerably damaged, the body will be susceptible to a host of life-threatening opportunistic diseases and cancers until death occurs.
Early medical attention can effectively delay progression and when administered properly, patients can continue to live normal and productive lives although they must employ special precautions to avoid contaminating other people.
HIV patients are treated with a combination of several medications. This regimen is called the antiretroviral therapy (ART). While the medicines cannot cure the virus, they control the spread and reduce the viral load or the number of HIV copies multiplied in the body. With a lower viral load, the immune system is maintained strong enough to fight off and recover from a number of infections and cancers. Having lesser HIV copies in the body also reduces the risk of transmitting the disease.
For instance, a research published in 1994 showed that the use of the drug called zidovudine or AZT by HIV-infected women and by their newborns reduced the risk of HIV transmission from about 25% to 8%. Another study showed that pregnant women who received at least two weeks of ART reduced the risk of perinatal transmission to less than 1 percent.
There are 6 major classes of drugs for HIV treatment, according to aids.gov. These are non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs), fusion inhibitors, CCR5 antagonists (CCR5), and integrase strand transfer inhibitors (INSTIs).
The 6 classes include several medicines, depending on how each fights the virus. There are 25 medicines that are currently approved for HIV treatment. A treatment regimen will usually combine at least three different medicines from at least two of the six categories, based on this article. A mixture of drugs is necessary to efficiently reduce the viral load and prevent resistance to medication.
In prescribing the medications, the doctor will consider several factors including the patient’s health history, results of other diagnostic tests performed after the diagnosis which measure the viral load in the patient’s body (e.g. CD4 Count), results of drug-resistance testing, possible side effects of the medicines, possible contraindications, convenience, and costs.
The drugs can cause several side effects. The most common reactions are nausea, vomiting, diarrhea, anemia, fatigue, dizziness, headaches, skin rashes, and insomnia. In considering an ART regimen, doctors will consider a combination of drugs that will efficiently control the disease with the least possible side effects.
ART is a lifetime treatment plan to which a patient must religiously adhere. His commitment to the regimen and to certain lifestyle changes will determine the effectiveness of the therapy and the quality of life he can expect while living with HIV.
Any concerns that arise while on certain medications should be discussed immediately with the health care provider or physician. Barriers to effective treatment should be reduced or eliminated as soon as possible.
While research continues to provide critical information for the development of advanced treatment plans and therapies, medications will not solve the global epidemic. The thrust of government and health agencies should focus more on education and prevention methods. Controlling and combatting the crisis requires a combination of measures including increasing access to screening methods and testing facilities, intensifying health campaigns, providing more HIV and AIDS support programs, and strengthening partnerships between government health agencies, communities, and the private sector to maintain effectual prevention programs.