April 24, 2014
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Infection

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HIV testing

Where to get tested

There are many locations where HIV testing is done. Most big cities have anonymous testing sites where you can request a test without giving your name. At these sites, you are assigned a code that will be used to label your test sample. When you come back for the result, simply give your code to identify your result. Your name will never be recorded on the chart.

Your family doctor can also arrange a test. If, however, you would rather not discuss this specific test with your family doctor, try a walk-in clinic or a clinic specializing in the diagnosis and treatment of sexually transmitted diseases. At any of these sites, you may request that the test sample be coded and that your name not be written on it. In this case, the testing laboratory will send the coded result back to the doctor who ordered the test. This doctor will then record the result in your chart and report it back to you. If you don't have a preference, the test will be sent to the laboratory with your name on it like most other medical tests. It's your choice.

Talking it over

Before the blood test, you will spend 15 to 20 minutes with a health care worker to have any of your questions answered, as well as to talk about the test and how you think you were infected. Information from this session will be carefully recorded in the medical chart, anonymously if you choose.

HIV blood tests

The two most important blood tests that you will have are the CD4 cell count (helper count, T helper count) and the HIV plasma viral load (viral load test).

The test itself

A number of HIV tests have been designed to work on the saliva, thereby removing the need to draw your blood. These tests are not widely used for routine testing and may not be as reliable as the blood test. Therefore, a blood test is your best bet.

The blood test itself is done in 2 stages: a first screening (ELISA) test and a second confirmatory (Western blot) test. Neither test measures the virus directly but rather the body's reaction to it.

  • If the ELISA test is negative, no further testing is done on your blood - you are not infected with HIV.
  • If the ELISA is positive, the Western blot is done. If the Western blot is then negative, the test is reported as negative. In this case, the initial positive ELISA result had nothing to do with HIV and is of no concern.
  • If the Western blot is positive, it indicates that your blood contains antibodies to HIV and a positive result is reported.

It is possible for the Western blot to give an indeterminate result, which indicates that you may have been exposed to HIV recently (perhaps within the previous 3 to 6 months) and that your body has not yet had time to develop antibodies to HIV. Or, it may mean nothing at all - something completely unrelated to HIV. If the test remains indeterminate over 3 to 6 months, this will confirm that you are not infected with HIV.

If you know that you have been exposed to HIV in the past 6 months, tell the doctor or the health care worker who is doing the test immediately. Although the tests may not be positive, there are additional tests that can be done that directly detect the virus itself, allowing HIV infection to be diagnosed right away.

Getting the result

You will be called back within 1 to 2 weeks to receive your result. Except under exceptional circumstances, these results are not given over the phone. If you call the office or clinic to get your result, it will generally not be given. Don't take this as an indication that the result is positive or "bad news". Most doctors feel that this information is so sensitive that it can only be given in person.

Don't be afraid to bring a friend or significant other for support. If the test result is negative, be prepared to discuss ways in which you can stay healthy. The health care worker will have some tips for you based on how you thought you were exposed to the infection.

By getting an HIV test you are acting responsibly and taking important health care decisions into your own hands. The more information you have before your test, the more useful and constructive an experience it will be.

 
Brian Conway, MD 
in association with the MediResource Clinical Team 

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