Call-On-Doc Focus: When to get Tested for HIV
Published on May 12, 2023 | 9:58 AM
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HIV, or human immunodeficiency virus, remains a significant global health concern. According to the CDC, 30,635 people were diagnosed in the United States in 2020, and it's estimated that over 1,189,700 Americans are living with the condition today with 87% of that number being aware. When it comes to the timely detection of HIV, the goal is to get screened after the window period. The window period is the time between potential exposure and when the test can accurately detect the related infection.
We can understand that the immediate reaction to a possible HIV infection is to get tested fast. However, HIV testing is somewhat different from others, with immediate or early testing proving inconclusive while doing so sometime after possible transmission proves far more accurate. Waiting the right amount of time after potential exposure to when you could test positive is important for accurate results. HIV also needs both screening and confirmation testing for the best possible treatment and follow-up procedures.
What types of tests are used for HIV?
Tests for HIV are split into two categories, screening and confirmation. Screening tests can involve oral or vaginal swabbing, but typically use blood with a pinprick or drawing for more accurate results. In such instances, these tests are known as:
- Rapid antibody
- Lab-based antibody
- Lab-based Antigen and Antibody
Most accurate when waiting out the full length of the window period, the confirmation test can result in a false negative if taken before the window period runs out. Additionally, tests like the rapid antibody can result in a false negative if taken outside of a professional environment or when blood is not used. In the case of a positive or false positive, the patient will then go through any of the following confirmation tests:
- Western Blot
- HIV-1/HIV-2 differentiation immunoassay
- Viral Detection
Each reviewed in a lab environment, confirmation tests are not meant for screening and work best with combination antigen and antibody tests. Initiated only after receiving a positive screening, these tests are reviewed in a laboratory and have a high degree of accuracy.
What’s the difference between screening and confirmation tests?
Screening tests are initial tests used to identify individuals who may have a particular condition, such as HIV, while confirmation tests are more specific and accurate tests performed to confirm a diagnosis in individuals who have tested positive on a screening test.
Screening tests aim to quickly identify a large number of individuals for further evaluation Generally coming in three different types, the most common types of screening tests are rapid antibody that deliver results in around 20 minutes, antibody tests reviewed in a lab, or a combination antibody and antigen test also reviewed in labs. The combination test is the most accurate because it gathers the most information.
Confirmation tests for HIV are specialized laboratory-based tests that are performed to confirm the presence of HIV infection in individuals who have tested positive on a screening test. More accurate than the screening tests, doctors typically prefer the Western blot. Unlike screening tests that detect HIV antibodies or antigens, confirmation tests directly detect specific HIV antibodies or the genetic material (RNA or DNA) of the virus. Confirmation tests help to rule out false-positive results and provide a definitive diagnosis, ensuring accurate identification of HIV infection and allowing for a greater degree of treatment to be initiated.
Can you test negative for HIV and still have it?
Yes, it is possible to test negative for HIV and still have the infection. This scenario can occur during what is known as the "window period" – the time between HIV infection and when the immune system produces enough antibodies or antigens to be detectable by HIV tests.
Depending on the type of test used, the window period can range from a few weeks to a few months. During this period, an individual may test negative despite being infected and capable of transmitting the virus to others. Therefore, it is important to consider the appropriate testing timeline and consult with healthcare professionals for an accurate interpretation of test results.
HIV symptoms in women vs men
While the severity of the condition differs on a case-by-case basis, there can be a subtle difference in HIV symptoms in women versus men. However, this is often on top of those that are shared, which are often described as flu-like. According to HIV.gov, around two-thirds of patients who develop HIV experience such symptoms that indicate the body is fighting the infection.
When it comes to describing the differences in HIV symptoms between men versus women, there are some indications that can be noticed when a person pays close attention to their body. According to WebMD, these differences affect the reproductive organs and the vagina, with the most common examples including:
- Abnormal vaginal discharge: HIV itself does not directly cause abnormal vaginal discharge. However, HIV can weaken the immune system, making individuals more susceptible to infections like urinary tract infections and intertriginous infections, among others.
- Frequent yeast infections: According to a 2017 study, a feature of HIV is its propensity to target the CD4+T cells. Destruction of such cells, and the immune system in general, make individuals more susceptible to infections, with the balance of the vaginal microbiota being particularly disrupted. This then leads to the overgrowth of infection-causing fungi like Candida and an increased likelihood of yeast infections.
- Irregular mensural cycle: A weakened immune system and hormonal imbalances caused by HIV can disrupt the menstrual cycle, leading to irregular periods or missed periods.
- Pain during sex: In a 2014 study, a direct correlation between HIV and women experiencing pain during sex. Known as dyspareunia (pain during sex), the symptom generally occurs due to vaginal dryness, urinary incontinence, potential infections, and the pelvic inflammatory disease associated with HIV.
- Pain during urination: Not necessarily directly causing painful urination, HIV can contribute by creating a good environment for infections that make urination unpleasant.
- Pelvic inflammatory disease: A large percentage of women who become infected with HIV often experience pelvic inflammatory disease or PID. In a 1997 study, a significant percentage of women with HIV had PID and were successfully treated. Additionally, The Lancet further confirms that HIV is one of the most common causes of PID in women who contract sexually transmitted diseases.
As detailed by PlannedParenthood, the vast majority of those who feel any HIV symptoms often do so within the two to four week period after transmission. In the instance that you do, such symptoms last for a few weeks before dying down, but that should not be taken as an indication that it is gone from your system.
While it might not feel like it, HIV will slowly continue to cause damage to your body and make you more susceptible to other diseases over time. According to the Mayo Clinic, HIV left untreated can result in the body developing acquired immunodeficiency syndrome or AIDS after 8 to 10 years.
What feels like HIV but isn’t?
In the instances that a person ignores the signs of HIV or does not get it effectively treated, it is most often mistaken for conditions like upper respiratory infections, a bad case of herpes, or other conditions that result in flu-like symptoms. According to WebMD and additional sources, common conditions that often get confused with HIV include:
- Allergic reactions
- Colds
- Gonnorhea
- Hepatitis
- Roseola
- Shingles
- Strep throat
When it comes to getting the assurance that you do or do not have HIV versus another condition, getting tested after the window period when you suspect a potential infection is crucial. Often, symptoms from HIV last longer than many other conditions. It is similarly imperative that you do not immediately get tested when symptoms arise as a negative test from an HIV test or screening may be a false negative.
Can you test too early for HIV?
Yes, it is possible to test too early for HIV. Such tests detect the presence of antibodies or antigens produced by the immune system in response to the virus, but can vice versa detect none in the time before the infection has a chance to set in.
During the initial stages of infection, known as the acute phase, it takes time for the body to develop detectable levels of these markers. Testing too early during this phase can result in a false negative result, as the test may not be able to detect the HIV infection yet.
Can HIV symptoms appear in 3 days?
No, HIV symptoms typically do not appear as early as 3 days after exposure to the virus. The acute phase of HIV infections, which occurs within 2 to 4 weeks after exposure, is when symptoms may start to manifest in some individuals.
However, the majority of people do not experience noticeable symptoms during this early stage. It's important to remember that symptoms alone cannot be relied upon to diagnose HIV, as they are non-specific and can resemble those of other illnesses, as referenced above. HIV testing is the most reliable way to determine infection status.
How accurate is an HIV test after 2 weeks?
HIV tests can provide a high level of accuracy after 2 weeks, but it is important to understand that no test can provide 100% accuracy during that timeframe. The accuracy of HIV tests increases as time progresses after exposure. While there may be some accurate readings, the chance to get a false negative is still high.
How accurate is an HIV test after 4 weeks?
After 4 weeks (28 days) following potential exposure to HIV, most modern HIV tests, including antibody-based tests and antigen/antibody combination tests, have a high accuracy rate. These tests can detect the presence of HIV antibodies or antigens with a high degree of reliability.
However, it's important to note that there is still a small possibility of false negatives during this period, particularly if the person is in the early stages of infection.
How soon can HIV be detected by a blood test?
The time it takes for HIV to be detected by a blood test depends on the type of test used and the individual's immune response to the virus. HIV tests detect the presence of antibodies or antigens produced by the immune system in response to the virus.
- Antibody-based tests can detect HIV infection within 2 to 8 weeks after exposure
- Antigen/antibody combination tests can detect HIV infection 2 to 4 weeks after exposure
However, it's important to note that there is a window period between HIV infection and the development of detectable antibodies or antigens, during which time the test may return false negative results. The window period can range from a few weeks to several months, depending on the type of test used.
Can it take longer than 6 months to test positive for HIV?
In the vast majority of cases, it does not take longer than 6 months to test positive for HIV. Modern HIV tests are highly accurate and can typically detect the presence of HIV antibodies or antigens within a few weeks to a few months after infection. The window period, which is the time between HIV infection and when the test can reliably detect the infection, is usually within 3 months (12 weeks).
However, in extremely rare cases, it is possible for individuals with specific medical conditions or compromised immune systems to have delayed seroconversion, where it takes longer for their bodies to produce detectable HIV antibodies. These cases are highly uncommon and are usually associated with severe immunodeficiency.
For the vast majority of individuals, a reliable HIV test at the appropriate window period, which is commonly around 3 months after exposure, can provide accurate results. If there are concerns or unique circumstances, it is always advisable to consult with healthcare professionals for personalized guidance.
Wayne C. Hahne,
English graduate and Call-On-Doc’s medical resource guide, Wayne C. Hahne is an experienced and passionate medical education content expert. Through diligent research, provider interviews and utilizing the industry's leading resources for wellness information, it is Mr. Hahne’s personal mission to educate the general public on medical conditions with in-depth and easy-to-understand written guides.
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