How HIV Is Diagnosed

The only way to diagnose the human immunodeficiency virus (HIV) is with an HIV test. There are a variety of such tests, some that use samples of blood, others that use saliva or urine. Testing typically takes place at a point-of-care location (a doctor's office, hospital, clinic, or even drugstore, for example). There also are tests that can be done at home (similar to home pregnancy tests). Some HIV tests look for the presence of the virus itself and others rely on the presence of antibodies to the virus created by the immune system.

In most cases, how or where a person is tested for HIV matters less than that they are tested—period. For someone who has been infected with HIV, early diagnosis is vital. It can make the difference between living a long and otherwise healthy life thanks to highly effective antiretroviral medications for HIV and succumbing to the serious illness.

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The Importance of Testing

The initial symptoms of HIV so resemble those of more innocuous viral infections that, unless they know they've been exposed to the virus (by engaging in risky behavior, for instance), most people aren't likely to suspect HIV infection.

Once the early symptoms resolve, the virus goes into a long remission during which it silently destroys cells in the immune system. It's not until this process has gone on long enough (typically eight to 10 years) that signs of compromised immunity begin to occur. This is the late stage of infection known as acquired immunodeficiency disease (AIDS).

At this point, treatment isn't likely to be effective, which is why public health organizations such as the U.S. Centers for Disease Control and Prevention (CDC) have specific guidelines for HIV testing based on factors such as age, sex, and lifestyle.

CDC HIV Testing Guidelines

  • Everyone ages 13 to 64: Get tested for HIV at least once as part of routine health care
  • People with risk factors for exposure to HIV: Get tested more frequently—at least annually, in most cases
  • Gay, bisexual, and other men who have sex with men (MSM): Get tested at least once a year
  • Sexually active MSM at increased risk of the infection: Get tested even more often, such as once every three or six months

In addition, because the human immunodeficiency virus can be passed along to an unborn child, the U.S. Preventive Services Task Force recommends that doctors "screen for HIV infection in all pregnant persons, including those who present in labor or at delivery whose HIV status is unknown."

Types of HIV Tests

Most of the available HIV tests are relatively accurate, although point-of-care tests tend to be more reliable than home tests, since these usually use a sample of blood and are conducted by trained clinicians, decreasing the likelihood of error.

There also are direct and indirect methods of detecting HIV:

  • Direct testing detects either antigens (proteins on the surface of the virus) or RNA (the virus’s genetic material)
  • Indirect testing screens for antibodies—proteins produced by the immune system in response to the virus
HIV Test Options
Option Method What It Tests For Wait for Results Good to Know
Rapid point-of-care tests Finger prick, oral swab of the gums, or urine sample HIV antigen and antibodies About 20 minutes The most accurate of these uses a blood sample—the combination HIV Ag/Ab test
Standard point-of-care tests Blood sample HIV antibodies Five to 10 days Also known as the HIV ELISA; now less common than the combination HIV Ag/Ab test
Rapid at-home tests Saliva HIV antibodies About 20 minutes More private, but less accurate than point-of-care tests
Home collection kits Drop of blood transferred to a test card and sent to a lab HIV antibodies About on business day after receipt by lab Can be difficult to obtain a blood sample on your own
Nucleic acid tests (NATs) Blood sample HIV RNA (genetic material) A couple of days Pricey; can detect HIV earlier than other types of tests; sometimes used to screen donated blood or newborns

With the exception of the NAT, a positive result from an HIV test is regarded as a preliminary positive, which means a second test will be needed to confirm the diagnosis.

A Word From Verywell

Being tested for HIV is nothing less than stressful, but it is absolutely necessary. If your results are negative, you can move forward with a better understanding of how to stay that way. If you are positive, you can begin HIV therapy that will allow you to live a long, healthy, and productive life.

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