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Specific tests for HIV include antibody and antigen detection (Table 31 2) Conventional HIV antibody testing is done by ELISA Positive specimens are then confirmed by a different method (eg, Western blot) The sensitivity of screening serologic tests is greater than 995% The specificity of positive results by two different techniques approaches 100% even in low-risk populations False-positive screening tests may occur as normal biologic variants or in association with recent influenza vaccination or other disease states, such as connective tissue disease These are usually detected by negative

Test HIV enzyme-linked immunosorbent assay (ELISA) Western blot Significance Screening test for HIV infection Of ELISA tests 50% are positive within 22 days after HIV transmission; 95% are positive within 6 weeks after transmission Sensitivity > 999%; to avoid false-positive results, repeatedly reactive results must be confirmed with Western blot Confirmatory test for HIV Specificity when combined with ELISA > 9999% Indeterminate results with early HIV infection, HIV-2 infection, autoimmune disease, pregnancy, and recent tetanus toxoid administration Screening test for HIV Produces results in 10 20 minutes Can be performed by personnel with limited training Positive results must be confirmed with standard HIV test (ELISA and Western blot) Anemia, neutropenia, and thrombocytopenia common with advanced HIV infection Most widely used predictor of HIV progression Risk of progression to an AIDS opportunistic infection or malignancy is high with CD4 < 200 cells/mcL in the absence of treatment Percentage may be more reliable than the CD4 count Risk of progression to an AIDS opportunistic infection or malignancy is high with percentage < 14% in the absence of treatment These tests measure the amount of actively replicating HIV virus Correlate with disease progression and response to antiretroviral drugs Best tests available for diagnosis of acute HIV infection (prior to seroconversion); however, caution is warranted when the test result shows low-level viremia (ie, < 500 copies) as this may represent a false-positive test

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HIV rapid antibody test Complete blood count Absolute CD4 lymphocyte count CD4 lymphocyte percentage HIV viral load tests

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confirmatory tests Molecular biology techniques (PCR) show a small incidence of individuals (< 1%) who are infected with HIV for up to 36 months without generating an antibody response However, antibodies that are detectable by screening serologic tests will develop in 95% of persons within 6 weeks after infection Rapid HIV antibody tests are now available They provide results within 10 20 minutes and can be performed in physician offices, including by personnel without laboratory training and without a Clinical Laboratory Improvement Amendment (CLIA) approved laboratory Persons who test positive on a rapid test should be told that they may be HIV-infected or their test may be falsely reactive Standard testing (ELISA with Western blot confirmation) should be performed to distinguish these two possibilities Rapid testing is particularly helpful in settings where a result is needed immediately (eg, a woman in labor who has not recently been tested for HIV) or when the patient is unlikely to return for a result Nonspecific laboratory findings with HIV infection may include anemia, leukopenia (particularly lymphopenia), and thrombocytopenia in any combination, elevation of the erythrocyte sedimentation rate, polyclonal hypergammaglobulinemia, and hypocholesterolemia Cutaneous anergy is common Several laboratory markers are available to provide prognostic information and guide therapy decisions (Table 31 2) The most widely used marker is the absolute CD4 lymphocyte count As counts decrease, the risk of serious opportunistic infection over the subsequent 3 5 years increases (Figure 31 1) There are many limitations to using the CD4 count, including diurnal variation, depression with intercurrent illness, and intralaboratory and interlaboratory variability Therefore, the trend is more important than a single determination The frequency of performance of counts depends on the patient s health status Patients whose CD4 counts are

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