TYPES OF HIV AND HIV

TESTING
 Types of HIV
There are two types of HIV that are currently recognized:
i. HIV-1
ii. HIV-2.
Transmission of both types of virus is through unprotected
sexual intercourse; through blood transfusion with infected
blood, or contact with other infected body fluids; from mother -
to -child, etc. Both types appear to cause clinically
indistinguishable AIDS disease.
HIV-1
Worldwide, HIV-1 is the predominant virus. This type of HIV is
responsible for the great majority of AIDS cases in the United
States, Europe and Africa. Because of its high rate of replication,
HIV-1 mutates rapidly into sub-types.
HIV-1 is further classified into four groups; M, N, O and P. Of
these, group M is the most widespread worldwide. Group M is
divided into nine distinct subtypes; A, B, C, D, F, G, H, J and K.
Two or more subtypes of HIV can combine to form a hybrid.
When this happens, the resulting form is known as a
'circulating recombinant form' (CRF). Another form this
hybrid might take is a ‘unique recombinant form’ (URF). This
is a viral sequence without any evidence of onward transmission.
Globally, almost half of all HIV-1 infections are of subtype C
(47%). Subtypes B and A are responsible for 12% and 10% of
infections, respectively, followed by the circulating recombinant
HIV-2

HIV-2 is another human retrovirus related to HIV-1,

causing a similar immune-deficiency because of
depletion of T-helper cells (CD4). Compared to HIV-1,
HIV-2 is less transmissible, and the period between
initial infection and illness is longer (Klatt, 2006). It is
associated with a lower viral burden, a slower rate of
both cell decline and clinical progression. HIV-2 also
appears to cause AIDS. It has been isolated in Africa
and is confined primarily to West Africa.
Center

for Disease Control (CDC)
An estimated 1.2 million people in the United States have HIV,
including about 161,800 people who are unaware of their
status. Nearly 40% of new HIV infections are transmitted by
people who don’t know they have the virus. For people with
undiagnosed HIV, testing is the first step in maintaining a healthy
life and preventing HIV transmission.
The CDC recommends a routine HIV test for adolescent and adult
patients aged 13 to 64 in all health care settings, of all women
during pregnancy, and the newborns of HIV-positive women.
Thus, HIV testing is now part of routine medical practice, similar
to tests that screen for other diseases
Importance of HIV Testing
People with HIV who are aware of their status can get
HIV treatment (called antiretroviral therapy or ART) and
remain healthy for many years. Studies show that the sooner
people start treatment after diagnosis, the more they benefit
from ART. Treatment with ART reduces the amount of HIV
in the blood (called viral load), reduces HIV-related illness,
and helps prevent transmission to others. People with HIV
who take HIV medicine as prescribed and get and keep an
undetectable viral load (or stay virally suppressed) have
effectively minimal risk of transmitting HIV to HIV-negative
sex partners.
People who get tested and learn they don’t have HIV can also
make decisions about sex, drug use, and health care that can
protect them from HIV.
Sero-conversion
 Seroconversion is the period during which the body starts
producing detectable levels of HIV antibodies. This usually
occurs several weeks after initially contracting the virus.
Symptoms of seroconversion may include:
fatigue
fever
a sore throat
a headache
body aches
swollen lymph nodes
a rash
Window

Period
The “window period” refers to the period between entry of the HIV
into the body and the production of antibodies by the host under
attack. During this time, the viruses multiply in the body, but they
cannot be detected because the antibodies are few in number or
are not present yet. This can range from 6 weeks to 12 weeks. Each
bacterium or virus induces the body to produce a very specific
kind of antibody. The HIV antibodies are specific only to HIV.
Viral load refers to the amount of the virus in the blood. People
who have high amounts of virus in their blood are more likely to
transmit the infection to others. As we saw in our earlier
discussions, HIV-infected individuals have especially high
amounts of virus in their blood soon after infection during the
window period, and again at the terminal stages of the natural
disease progression. It also happens when there is re-infection
with a new virus. High viral loads increase the risk of transmission
for all routes.
Body Fluids Tested for HIV
 Many types of specimens can be used for biological surveillance of HIV:
 Plasma- Plasma is the clear, straw-colored liquid portion of blood that remains
after red blood cells, white blood cells, platelets and other cellular components
are removed.
 Serum- Serum (/ˈsɪərəm/) is the fluid and solute component of blood which
does not play a role in clotting. It may be defined as blood plasma without the
clotting factors, or as blood with all cells and clotting factors removed. If the
person has been infected with HIV, the antibodies in the serum will bind to the
HIV proteins, and the extent of this binding can be measured.
 Whole blood
 DBS-Dried blood spots (DBS)-DBS may be particularly useful for HIV
screening in remote areas, in which unrefrigerated transfer time to a laboratory
may take time.
 Oral fluid. The choice of specimen collected depends on the logistics,
populations and sites selected, and the HIV testing strategy and algorithm.
Specimens must be collected, tested and stored in an appropriate manner in
order to obtain accurate and reliable results.
 NB: Blood (serum, plasma, DBS) is the preferred specimen for testing
because it has a higher concentration of HIV antibodies than oral fluid
HIV

Tests for Screening and Diagnosis
HIV tests are very accurate, but no test can detect the virus immediately after infection. How soon a
test can detect HIV depends upon different factors, including the type of test being used. There are
three types of HIV diagnostic tests: nucleic acid tests (NAT), antigen/antibody tests, and antibody
tests.
 Nucleic Acid Tests (NATs) look for the actual virus in the blood. It is also known as HIV RNA test
(Polymerase Chain Reaction-PCR Test). It can detect genetic material from the virus in blood. This
test is very expensive and is not routinely used for HIV screening unless the person recently had a
high-risk exposure or a possible exposure with early symptoms of HIV infection. A NAT can usually
detect HIV infection 10 to 33 days after an exposure. This test are important for new born babies.
 Antigen/antibody tests look for both HIV antibodies and antigens. HIV antigen/antibody tests are
also known as combination tests or fourth generation tests. This type of test can detect proteins (or
antigens) from HIV, as well as antibodies for HIV. Antibodies are produced by your immune system
when you’re exposed to viruses like HIV. Antigens are foreign substances that cause your immune
system to activate. If you have HIV, an antigen called p24 is produced even before antibodies
develop. Antigen/antibody tests are recommended for testing done in labs and are now common in
the United States. An antigen/antibody test performed by a laboratory on blood from a vein can
usually detect HIV infection 18 to 45 days after an exposure. There is also a rapid antigen/antibody
test available that is done with a finger prick. Antigen/antibody tests done with blood from a finger
prick can take longer to detect HIV (18 to 90 days after an exposure).
 Antibody tests look for antibodies to HIV in your blood (Elisa Test)or oral fluid. Oraquick is an
Oral swab based HIV Self-Test that does not require blood. Antibody tests can take 23 to 90 days to
detect HIV infection after an exposure. Most rapid tests and the only FDA-approved HIV self-test
are antibody tests. In general, antibody tests that use blood from a vein can detect HIV sooner after
infection than tests done with blood from a finger prick or with oral fluid. Indirect fluorescent
antibody (IFA). This test detects HIV antibodies using a special fluorescent dye and a microscope.
This test may be used to confirm the results of an ELISA test.
Can HIV be detected in Plasma?
 Plasma is the single largest component of human blood, comprising about 55
percent, and contains water, salts, enzymes, antibodies and other proteins.
 Yes, HIV can be detected in Plasma through a plasma viral load test (also
called a PVL test) which measures how much HIV is in your blood. The
amount of virus in your blood is called your viral load. Viral load testing is
designed to measure the amount of HIV RNA in plasma. Plasma is therefore
the preferred sample type for viral load testing
 If you have not started taking medicines for HIV infection, your doctor will
usually want to test your PVL several times a year to see if the amount of HIV
in your blood is changing.
 Three different PVL tests are used:
i. The polymerase chain reaction (PCR) test
ii. The branched-chain DNA (bDNA) test-
iii. The nucleic acid sequence-based amplification (NASBA) test
 There is no cure for HIV infection, but keeping a low PVL level helps you feel
well.
Special tests show that even people with undetectable levels of HIV still have very
small amounts of the virus in their blood. So even if your HIV level is
undetectable, you need to get PVL tests several times a year. You could still infect
HIV Follow Up/Assessment
 An initial HIV test usually will either be an antigen/antibody test or an
antibody test. If the initial HIV test is a rapid test or a self-test and it is
positive, the individual should go to a health care provider to get follow-up
testing. If the initial HIV test is a laboratory test and it is positive, the
laboratory will usually conduct follow-up testing on the same blood sample
as the initial test. Although HIV tests are generally very accurate, follow-up
testing allows the health care provider to be sure the diagnosis is right.
 Two surrogate markers are used to monitor people with HIV:
I. Plasma HIV RNA (viral load) to assess level of HIV viremia
II. CD4 T lymphocyte cell count to assess immune function.
NASCOP-HIV Self Testing Cont.
There are many possible models in which HIV rapid tests
could be made available for the purpose of self testing
which vary in the amount of support that is provided
(supervised or unsupervised), level of access (clinically
restricted, semi-restricted, or open access) and how and
where HIV rapid tests are distributed or performed (facility-
based, community-based, or other. HIVST should be
performed using approved HIV rapid diagnostic tests that
use either finger stick whole blood or oral fluid (mouth
swab). HIVST does not provide a diagnosis. All reactive
(positive) self-test results should be confirmed in a health
facility according to nationally set standards.
HIV TESTING AND COUNSELLING
PROTOCOL
The primary components of HTS service package include:
i. Pre-test session
ii. HIV test
iii. Post-test session
iv. Referral and linkage to other appropriate health services
v. Assessment of other health related conditions such as
Tuberculosis
These five elements make up the minimum service package of
HTC. The package is aimed at enabling the clients to
understand their HIV risk, take the HIV test, come up with a
risk reduction plan, and take up appropriate referrals.
STEP 1- PRE-TEST COUNSELING
 The pre-test session introduces basic HIV information to the client wishing to
receive a HIV test, and may be provided to an individual or a couple. Group
information is not part of the pre-test session. Clients should be given
opportunity to give consent to be tested. Confidentiality and its exception
should be explained to the client.
 The objectives of the pre-test session are to:
i. Obtain informed consent for HIV test
ii. Give information on the benefits of knowing one’s HIV status
iii. Explain the benefits of couple testing
iv. Prepare the client for the HIV test and provide an explanation for the HIV
testing process
v. Explore/discuss the client’s risk of HIV infection
vi. Discuss the importance of disclosure to partners and other family members
and health providers.
Step 2-During Testing
HIV Test-The goal of HIV testing is to:
i. Conduct an HIV test as per the nationally approved
testing algorithm
ii. Provide correct same day session HIV test results
Post-Test Counseling
The goal of the post-test counseling for both HIV positive and negative
results is to achieve the following;
i. Communicate the HIV test results
ii. Assess the client’s understanding of the test results
iii. Discuss referral to care and treatment for HIV positive clients and
benefits of early treatment and adherence.”
iv. Development of client’s risk reduction plan
v. Review disclosure options and partner testing
vi. Referral to additional prevention services , especially for high risk
HIV negative persons as needed
vii. Condoms and lubricant demonstration and issuance The need for
quality post-test counseling cannot be overemphasized. The
client’s uptake of post-test referral and adoption of safe sex
behavior is dependent on the quality of the post-test session. The
posttest counseling session should be tailored to the test results
and the clients HIV risk assessment.
How accurate are HIV tests?
In general, current HIV tests are highly accurate. HIV test
accuracy depends on several factors, including:
the type of test used
how soon a person is tested after being exposed to HIV
how a person’s body responds to HIV
When a person first contracts HIV, the infection is considered
acute. During the acute stage, it’s difficult to detect. Over time, it
becomes chronic and easier to diagnose with tests.
NB
A false-positive result happens when a person who doesn’t have
HIV receives a positive result after being tested for the virus.
A false-negative result happens when a person who has HIV
receives a negative result after being tested for the condition. False-
negative results are less common than false-positive results,
although both are rare.
THANK YOU