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PFS005 Testing for Human Immunodeficiency Virus The American College of Obstetricians and Gynecologists Women’s Health Care Physicians patient education Fact Sheet PFS005: Testing for Human Immunodeficiency Virus DECEMBER 2013 Human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). HIV can enter the bloodstream through contact with body fluids of an infected person, such as blood or semen. This can happen during sex or by sharing needles used to inject drugs. An infected woman who is pregnant can pass the virus to her baby. Women with HIV who breastfeed also can pass the virus to their babies. Once in the blood, HIV attacks the immune system. As the immune system weakens, the body becomes less able to resist disease and other infections. AIDS is diagnosed when a person with HIV begins to develop diseases that the immune system normally would fight off, such as pneumonia, certain types of cancer, and harmful infections. Why Get Tested It can take months or years before HIV infection might develop into AIDS. Unless you are tested, you may not know you are infected with HIV until you get sick. Knowing your HIV status is critical for your health and the health of others. Early diagnosis and treatment with anti-HIV drugs can help people with HIV infection stay healthy for a long time and can decrease the chance of passing the virus to others. Women who are infected with HIV also can take steps to avoid unintended pregnancy so that they are in the best possible health when they do become pregnant. Pregnant women infected with HIV can reduce the risk of passing the virus to their babies by following certain guidelines. Who Should Be Tested All women and men aged 19–64 years should be tested for HIV at least once in their lifetime. People in other age groups also may need to be tested depending on their risk factors, such as teenagers younger than 19 years who are currently sexually active or who have had sex in the past. You should not be tested without your knowledge. HIV testing is provided in two ways: 1. Opt-out testing—Your health care provider informs you (either during a conversation or in writing) that HIV testing will be performed as a part of routine health care. You can choose not to be tested. 2. Opt-in testing—Your health care provider must ask you if you want the test. You may need to sign a consent form to have the HIV test. Your state, city, or county may have specific laws about HIV testing. Contact your state health department to find out the laws about HIV testing in your area. How HIV Testing Is Done There are two general types of HIV tests: 1) screening tests and 2) confirming tests. The HIV screening test looks for the presence of HIV antibodies in a sample of your blood. Urine and oral fluid (fluid that is taken from between the cheek and gum) also can be used. It can take up to 2 weeks to get the results. If antibodies are present, the test result is positive. However, a positive screening test result needs to be confirmed with a different type of test. This confirming test measures the level of antibodies to specific proteins that are present in HIV. Results take about 2 weeks. If the confirming test result is positive, then you are infected with HIV. Another type of test is called a rapid HIV test. This type of test uses a blood sample or a sample of oral fluid. With rapid HIV testing, results can be available in less than an hour. A home test kit also is available that tests a sample of blood that you obtain by pricking your finger. You send the sample to a lab and then call the lab for the results. Both the rapid test and the home test are screening tests. If results of either of these tests are positive, you will need to have a confirming test. How Often Should You Be Tested It takes time for the body to make enough antibodies to be detected by the test. If you were infected recently, your antibody test result could be negative, and it may take 3–6 months for you to test positive. Retesting is recommended at least annually if you • inject (shoot) illegal drugs • have a sex partner who is an injection drug user or is infected with HIV • exchange sex for drugs or money • have received another sexually transmitted disease diagnosis in the past year • have had more than one sex partner since your most recent HIV test It also is a good idea for you and your partner to be tested before starting a new sexual relationship. If You Test Positive for HIV A positive HIV test result only tells you that you are carrying the virus. It does not tell you whether you have AIDS or if you will get sick. If you are infected with HIV, you should see a health care provider, even if you do not feel sick. You may be referred to a health care provider or group of health care providers who specialize in caring for people infected with HIV. Many drug therapies are now available that can keep people infected with HIV healthy for a long time. Your health care provider will report your test results anonymously to your state health department. This is done to keep track of how many people in the United States have HIV. You should tell all of your sexual partners and needle-sharing partners about your HIV status so that they can be tested. In some states, you can be charged with a crime for not revealing that you are HIV positive before engaging in behavior that can transmit the virus. Some state health departments require health care providers to report the names of sexual or needle-sharing partners of patients who test positive for HIV if they know this information, even if you do not want to report the information yourself. You can find out information about your state by going to http://www.cdc. gov/hiv/policies/law/states/index.html. Pregnant Women and HIV Testing If you are pregnant and infected with HIV, the virus can be passed to your baby. The good news is that treatment during pregnancy can greatly reduce the chance of this happening. Treatment during pregnancy also can help you stay healthy. Treatment includes the following steps: • Take a combination of anti-HIV drugs during your pregnancy as prescribed. • Have your baby by cesarean delivery if lab tests show that your level of HIV is high. • Take anti-HIV drugs during labor and delivery as needed. • Give an anti-HIV drug to your baby after birth. • Do not breastfeed. By following these guidelines, 99% of HIV-infected women will not pass HIV on to their babies. The key to protecting your baby against HIV is to get tested as early as possible during pregnancy. If you are at increased risk of infection, you should have another HIV test in the third trimester of your pregnancy. Women who have not been tested for HIV during pregnancy should have a rapid HIV test when they go into labor. It is important to have this test because anti-HIV drugs can be given during labor and delivery that can decrease the risk of transmitting the virus to the baby. If the mother has HIV, the baby should receive treatment as soon as possible after birth. She also can receive treatment for HIV infection for her own health. For More Information If you have questions about HIV, AIDS, or HIV testing, the following links may be helpful: • National HIV and STD Testing Resources (http://hivtest.cdc.gov) Offers general information about HIV and sexually transmitted infection (STI) testing and gives testing locations. • Centers for Disease Control and Prevention HIV/AIDS Resources (http://www.cdc.gov/hiv) Provides comprehensive information about HIV and AIDS. • AIDS.gov Network of web sites providing information about the federal government’s HIV/AIDS programs; also includes a testing and care locator service as well as information about living with HIV. Glossary Acquired Immunodeficiency Syndrome (AIDS): A group of signs and symptoms, usually of severe infections, occurring in a person whose immune system has been damaged by infection with human immunodeficiency virus (HIV). Antibodies: Proteins in the blood produced in reaction to foreign substances, such as bacteria and viruses that cause infection. Cesarean Delivery: Delivery of a baby through surgical incisions made in the mother’s abdomen and uterus. Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system and causes acquired immunodeficiency syndrome (AIDS). Immune System: The body’s natural defense system against foreign substances and invading organisms, such as bacteria that cause disease. PFS005: Designed as an aid to patients, this document sets forth current information and opinions related to women’s health. The information does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations, taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice, may be appropriate. Copyright December 2013 by the American College of Obstetricians and Gynecologists. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.