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(human immunodeficiency virus)
• are used to detect the presence of the human
immunodeficiency virus (HIV), the virus that causes acquired
syndrome(AIDS), in serum, saliva, or urine. Such tests may
detect antibodies, antigens, or RNA.
• is a process that determines whether a person is infected with
The symptoms of HIV and AIDS vary, depending on the phase of
• The majority of people infected by HIV develop a flu-like illness within a
month or two after the virus enters the body. This illness, known as primary
or acute HIV infection, may last for a few weeks. Possible symptoms
Mouth or genital ulcers
Swollen lymph glands, mainly on the neck
Early symptomatic HIV infection
• As the virus continues to multiply and destroy immune cells, you
may develop mild infections or chronic symptoms such as:
Swollen lymph nodes — often one of the first signs of HIV infection
Cough and shortness of breath
• HIV testing detects antibodies or antigens associated with HIV in whole
blood, saliva, or urine. Blood sampling is the most common mode of testing. The
results of different tests can be combined to confirm HIV test results.
All testing follows the same basic steps:
• 1. Sample is obtained. Most often, a blood sample is taken from a person's
fingertip or arm.
• 2. Sample is processed. This can be done on site—for example, at the ANC clinic
or in labor and delivery for rapid tests—or in a laboratory.
• 3. Healthcare worker obtains results.
• 4. Healthcare worker provides results to the patient during post-test counseling.
o ƒ In an adult, a positive HIV antibody test result means that the person is
infected with HIV.
o ƒ A negative result usually means that the person is not infected with HIV.
o In rare instances, a person with a negative or inconclusive result may be in the
―window period.‖ This is the period of time between the onset of infection with
HIV and the appearance of detectable antibodies to the virus. The window period
lasts for 4 to 6 weeks but occasionally up to 3 months after HIV exposure.
Persons at high risk who initially test negative should be retested 3 months after
exposure to confirm results.
• 5. Healthcare worker provides post-test counseling, support, and referral.
• When HIV enters the body, the body responds by making
a protein called an antibody that can be detected by one
of several methods:
ƒ Rapid HIV test
ƒ Enzyme-linked immunosorbent assay (ELISA)
ƒ Western blot test
• All rapid tests share the following characteristics:
• ƒ Highly accurate when performed correctly.
• ƒ Usually performed on whole blood (either taken as a
finger prick or drawn as a sample); occasionally saliva is
collected by using a swab
• ƒ Do not require special laboratory equipment or
• ƒ Results are ready within 30 minutes
• ƒ Tests can be done on a single specimen
• ƒ Clinic staff can be trained to perform the tests
Enzyme-linked immunosorbent assay
• ELISA is also used to identify antibodies to HIV in blood, urine, or saliva.
Generally, a blood sample is taken with a needle from a vein in the arm, and sent
to a laboratory for testing by technicians.
The limitations of ELISA include the following:
• ƒ Tests are done in batches of 40−90 specimens.
• ƒ Positive results must be confirmed either with another ELISA (using a test kit
from a different manufacturer) or by Western blot. The Western blot is a highly
―specific‖ antibody test because it is particularly accurate in providing a negative
test result on samples from people who are truly negative. Both confirmatory
tests can be done on the initial blood sample.
• ƒ Reporting of results may take several days or weeks, and women may not
return for test results or may give birth before the results are ready.
• ƒ Laboratories and trained laboratory technicians are required.
• ƒ The test is sensitive to temperature, and reagents require refrigeration.
• Results for these tests can take up to two weeks.
• The Western blot assay is used to conform seropositivity when the ELISA result
is positive. Adult whose blood contains antibodies for HIV are seropositive.
In addition to this HIV-1 antibody assay, two additional
technique are now available.
The OraSure test uses saliva to perform an ELISA antibody
test. Using less than drop of blood, the OraQuick Rapid HIV-1
Antibody Test quickly (approximately 20 minutes) and reliably
(99.6% accuracy) detects antibodies to HIV-1. The OraQuick
test is becoming the standard method of testing in setting
where a delay would seriously affect treatment, such as in
labor and delivery rooms or in emergency departments when
the HIV status of a sexual abuset is unknown.
Home-based testing for HIV antibodies using a small amount
of blood was first proposed in 1985 and approved in the FDA
in 1995. However, use of home testing kits raises concerns
because of the lack of counseling and possible inaccurative
results, including both false-negative results.
HIV Test results: Implications for Patients
Interpretation of Positive Test Results
• Antibodies to HIV are present in the blood (the patient has been infected with
the virus, and the body has produced antibodies)
• HIV is active in the body, and the patient can transmit the virus to others.
• Despite HIV infection, the patient does not necessarily have AIDS.
• The patient is not immune to HIV (the antibodies do not indicate immunity)
Interpretation of Negative Test Results
• Antibodies to HIV are not present in the blood at this time, which can mean
that the patient has not been infected with HIV or, if infected, the body has not
yet produced antibodies (window period-usually 3 weeks to 6 months).
• The patient should continue the precautions. The test result does not mean that
the patient is immune to the virus, nor does it mean the patient is not infected, it
just means that the body may not have produced antibodies yet.
PRE-TEST Patient Preparation
An informed witnessed consent from must be properly
singed by any person being tested for HIV/AIDS.
It is essential that counseling precedes and follows the HIV
antibody test. This test should not be informed without the
subject’s informed consent, the persons who need to access
results legitimately must be mentioned.
Assess frequency and intensity of symptoms: elevated
temperature, anxiety, fear,, diarrhea, neuropathy, nausea
and vomiting, depression, and fatigue.
Infection control measures mandate use of standard
POST-TEST Patient Preparation
• Interpret test outcomes. Explain significance of
test result along with CD4 cell counts.
• Advise patient that screening tests must be
confirmed before the results are reported as HIV
reactive. Provide options for immediate
counseling if necessary. Explain treatment with
potent antiviral drugs and protease inhibitors.
• HIV infection weakens your immune system, making you highly
susceptible to all sorts of infections and certain types of cancers such
as Kaposi's sarcoma is a tumor of the blood vessel walls. Lymphomas
is the type of cancer originates in your white blood cells. Lymphomas
usually begin in your lymph nodes.
• Tuberculosis (TB). In resource-poor nations, TB is the most
common opportunistic infection associated with HIV and a leading
cause of death among people living with AIDS. Millions of people
are currently infected with both HIV and tuberculosis, and many
experts consider the two diseases twin epidemics.
• Salmonellosis. You contract this bacterial infection from
contaminated food or water. Although anyone exposed to salmonella
bacteria can become sick, salmonellosis is far more common in
people who are HIV-positive.
• Cytomegalovirus (CMV). This common herpes virus is transmitted
in body fluids such as saliva, blood, urine, semen and breast milk.
• Candidiasis is a common HIV-related infection.
Treatment for HIV
A triple drug regimen has been used effectively containing:
Zidovudine – formerly azidothymidine
Medications for HIV
• There's no cure for HIV/AIDS, but a variety of drugs can be used in combination to control the virus. Each
of the classes of anti-HIV drugs blocks the virus in different ways. It's best to combine at least three drugs
from two different classes to avoid creating strains of HIV that are immune to single drugs. The classes of
anti-HIV drugs include:
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs). NNRTIs disable a protein needed by HIV to
make copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine
• Nucleoside reverse transcriptase inhibitors (NRTIs). NRTIs are faulty versions of building blocks that
HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs
emtricitabine and tenofovir (Truvada), and lamivudine and zidovudine (Combivir).
• Protease inhibitors (PIs). PIs disable protease, another protein that HIV needs to make copies of itself.
Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and ritonavir
• Entry or fusion inhibitors. These drugs block HIV's entry into CD4 cells. Examples include enfuvirtide
(Fuzeon) and maraviroc (Selzentry).
• Integrase inhibitors. Raltegravir (Isentress) works by disabling integrase, a protein that HIV uses to insert
its genetic material into CD4 cells.
• KS: alpha-interferon, surgical excision of lesions, liquid
nitrogen to lesions, vinblastine injected into intraoral
lesions, interferon; chemotherapy with doxorubicin
(Adriamycin), bleomycin, and vincristine (ABV);
• Lymphomas: limited successful treatment; chemotherapy
and radiation therapy may be used.
• Textbook of Medical-Surgical Nursing, 12
Edition, Brunner & Suddarth’s, Volume 1 & 2.
• Handbook for Textbook of Medical-Surgical Nursing, 10
Edition, Brunner & Suddarth’s, by Joyce Young Jonhson
• A Manual of Laboratory and Diagnostic Tests, 7
Edition, by Frances Fischbach