Human Immunodeficiency Virus - HIV

Human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome (AIDS). Pre- and postexposure treatments have become available to avoid contracting HIV, and therapy is available to treat HIV infections. However, infection rates remain high among at-risk populations. HIV remains a major public health problem. Screening in asymptomatic individuals and early identification of active disease are critical.

Tabs Content

Clinical Overview

Key Points

HIV clinical symptoms by stage
- Acute retroviral syndrome – fever, fatigue, rash, headache, lymphadenopathy, pharyngitis, myalgias, nausea, vomiting, diarrhea, and night sweats
  - Develops 1-4 weeks after exposure
  - Symptoms are too vague to distinguish acute HIV from other viral illnesses
- Latency period without symptoms
  - 2-8 years
- Early chronic infection phase
  - Persistent fever
  - Diarrhea
  - Adenopathy
  - Chronic oral and cutaneous conditions
- End stage disease (AIDS)
  - CD4+ <200 cells/µL
  - Opportunistic infections – viral, bacterial, fungal
  - Malignancies – Kaposi sarcoma, non-Hodgkin lymphoma (NHL), invasive cervical cancer, primary brain lymphoma
  - Chronic metabolic complications – dyslipidemia, impaired glucose tolerance, lipodystrophy, wasting

Indications for laboratory testing

At-risk patients
- Individuals with symptoms of infection
- Individuals with recent exposure to HIV-infected individual
- Individuals with history of high-risk behaviors
- Pregnant individuals
- Infants born to HIV-positive mothers
Guideline recommendations for HIV screening
- CDC, 2006 (endorsed by American College of Obstetricians and Gynecologists [ACOG], American College of Physicians [ACP], Infectious Diseases Society of America [IDSA], American Academy of Family Physicians [AAFP])
  - All patients ages 13-64 years in all healthcare settings
  - Patients at high risk for HIV – annual screening (CDC, 2017)
  - Pregnant women – routine prenatal screening
- U.S. Preventive Services Task Force (USPSTF) (Moyer, 2013)
  - All adolescents and adults ages 15 to 65 years
  - At-risk younger adolescents and older adults
  - Pregnant women including those who present in labor who are untested and whose HIV status is unknown

Recommended Laboratory Testing^a
Refer to ARUP's testing algorithms Human Immunodeficiency Virus in Adults Testing algorithm (based on the CDC Updated Recommendations: Laboratory Testing for the Diagnosis of HIV Infection, June 27, 2014) Human Immunodeficiency Virus in Infants Testing algorithm
Rapid Screening Diagnostic Test (Point-of-Care)
Point-of-care test	Test Description Can be performed in point-of-care settings Provides results within minutes Limitation Not positive until 3-5 wks after exposure Follow-up Refer to ARUP's Human Immunodeficiency Virus in Adults Testing algorithm Preliminary positive results must be followed up with 4th generation Ag/Ab laboratory-based assay (including preliminary positive results obtained with Alere Determine HIV-1/2 Ag/Ab Combo rapid test)
4th Generation HIV-1 p24 Antigen and Antibodies to HIV-1 (groups M and O) and HIV-2 Screen
Human Immunodeficiency Virus (HIV) Combo Antigen/Antibody (HIV-1/O/2) by CIA, Reflexive Panel 2012674	Test Description Recommended test that satisfies 2014 CDC Recommended Algorithm for Laboratory Diagnosis of HIV infection 4th generation qualitative screen for HIV-1 p24 antigen and antibodies to HIV-1 (groups M and O) and HIV-2 Antibody/antigen combination testing reduces diagnostic window by 5-7 days when compared to antibody-only assay Reflex portion of the test confirms and discriminates between HIV-1 and HIV-2 antibodies Reflex Pattern If HIV-1, 2 combo antigen/antibodies screen is repeatedly reactive, confirmation by antibody differentiation test is added Negative or indeterminate results for HIV-1/2 antibody differentiation are confirmed with a quantitative PCR test Follow-up Refer to ARUP's HIV in Adults Testing algorithm
Human Immunodeficiency Virus (HIV) Combo Antigen/Antibody (HIV-1/O/2) by CIA, with Reflex to HIV-1 Antibody Confirmation by Western Blot 2006526	Test Description 4th generation qualitative screen simultaneously detects HIV-1 p24 antigen and antibodies to HIV types 1 and 2 Antibody/antigen combination testing reduces diagnostic window by 5-7 days when compared to antibody-only assay Reflex Pattern If HIV-1, 2 combo antigen/antibody screen is repeatedly reactive, confirmation by western blot is added Limitation Does not distinguish between the presence of HIV-1 p24 antigen, HIV-1 antibody, and HIV-2 antibody Follow-up Refer to ARUP's HIV in Adults Testing algorithm
Human Immunodeficiency Virus (HIV) Combo Antigen/Antibody (HIV-1/O/2) by CIA, with Reflex to HIV-1/HIV-2 Antibody Differentiation, Supplemental 2013333	Test Description 4th generation qualitative screen simultaneously detects HIV-1 p24 antigen and antibodies to HIV 1 (groups M and O) and HIV-2 Antibody/antigen combination testing reduces diagnostic window by 5-7 days when compared to antibody-only assay Reflex Pattern Repeatedly reactive HIV-1, 2 combo antigen/antibody screen will reflex to HIV-1/HIV-2 antibody differentiation Limitation Does not complete the 2014 CDC Recommended Algorithm for Laboratory Diagnosis of HIV Infections Preferred test is Human Immunodeficiency Virus (HIV) Combo Antigen/Antibody (HIV-1/O/2) by CIA, Reflexive Panel 2012674 Follow-up Refer to ARUP's HIV in Adults Testing algorithm
3rd Generation HIV-1, HIV-2 Antibody Screen
Human Immunodeficiency Virus Types 1 and 2 (HIV-1, HIV-2) Antibodies by CIA with Reflex to HIV-1 Antibody Confirmation by Western Blot 2005377 Also available – HIV-1-only antibody screen with western blot confirmation Human Immunodeficiency Virus Type 1 (HIV-1) Antibody by CIA with Reflex to HIV-1 Antibody Confirmation by Western Blot 2005375	Test Description Qualitative test detects antibodies to HIV types 1 and 2 Reflex Pattern If HIV-1, 2 antibodies screen is repeatedly reactive, confirmation by western blot is added Limitation Not positive until 3-5 wks after exposure Follow-up Refer to ARUP's HIV in Adults Testing algorithm
Confirmation Tests Following Repeatedly Reactive 3rd or 4th Generation Test
Human Immunodeficiency Virus Types 1 and 2 (HIV-1/2) Antibody Differentiation, Supplemental, with Reflex to HIV-1 Quantitative PCR 2012669	Test Description Useful as a supplemental assay for repeatedly reactive 3rd or 4th generation HIV screen tests when following the CDC HIV Diagnostic Algorithms Limitation Test cannot be used as a rapid screen, nor as a follow-up for a positive rapid screen Follow-up Refer to ARUP's HIV in Adults Testing algorithm
Human Immunodeficiency Virus Type 1 (HIV-1) Antibody Confirmation by Western Blot 0020284	Test Description Use only when a specimen is repeatedly reactive for HIV-1 or HIV 1/2 antibodies Limitation Test cannot be used as a rapid screen Follow-up Refer to ARUP's HIV in Adults Testing algorithm
Human Immunodeficiency Virus Types 1 and 2 (HIV-1/2) Antibody Differentiation, Supplemental 2013107	Test Description Discriminates between HIV-1 and HIV-2 antibodies Use only when patient has a repeatedly reactive 3rd- or 4th-generation HIV screen test result Limitation Test cannot be used as a rapid screen Follow-up Refer to ARUP's HIV in Adults Testing algorithm
Follow-Up Testing for HIV Confirmation Test
HIV Quantitative PCR Human Immunodeficiency Virus 1 by Quantitative PCR 0055598	Test Description Quantitative test May be ordered to detect acute HIV infection Use to determine and monitor therapy in confirmed HIV cases
HIV Qualitative PCR Human Immunodeficiency Virus 1 (HIV-1) by Qualitative PCR 0093061	Test Description Qualitative test detects HIV-1 DNA and RNA in infants For initially positive test, recommend repeat testing at 1-2 mos and 3-6 mos of age to confirm diagnosis
CD4 Lymphocyte Counts Lymphocyte Subset Panel 1 – CD4 Absolute Count Only 0095854	Test Description Quantitative test Absolute CD4 count is sufficient for routine HIV monitoring Order concurrently with HIV viral load testing for monitoring treatment and disease
^a All linked tests are offered by ARUP Laboratories CIA, chemiluminescent immunoassay; PCR, polymerase chain reaction

Recommended Laboratory Testing^a

Refer to ARUP's testing algorithms

Human Immunodeficiency Virus in Adults Testing algorithm (based on the CDC Updated Recommendations: Laboratory Testing for the Diagnosis of HIV Infection, June 27, 2014)
Human Immunodeficiency Virus in Infants Testing algorithm

Rapid Screening Diagnostic Test (Point-of-Care)

Point-of-care test

Test Description

Can be performed in point-of-care settings
Provides results within minutes

Limitation

Not positive until 3-5 wks after exposure

Follow-up

Refer to ARUP's Human Immunodeficiency Virus in Adults Testing algorithm
Preliminary positive results must be followed up with 4th generation Ag/Ab laboratory-based assay (including preliminary positive results obtained with Alere Determine HIV-1/2 Ag/Ab Combo rapid test)

4th Generation HIV-1 p24 Antigen and Antibodies to HIV-1 (groups M and O) and HIV-2 Screen

Human Immunodeficiency Virus (HIV) Combo Antigen/Antibody (HIV-1/O/2) by CIA, Reflexive Panel 2012674

Test Description

Recommended test that satisfies 2014 CDC Recommended Algorithm for Laboratory Diagnosis of HIV infection
4th generation qualitative screen for HIV-1 p24 antigen and antibodies to HIV-1 (groups M and O) and HIV-2
- Antibody/antigen combination testing reduces diagnostic window by 5-7 days when compared to antibody-only assay
Reflex portion of the test confirms and discriminates between HIV-1 and HIV-2 antibodies

Reflex Pattern

If HIV-1, 2 combo antigen/antibodies screen is repeatedly reactive, confirmation by antibody differentiation test is added
Negative or indeterminate results for HIV-1/2 antibody differentiation are confirmed with a quantitative PCR test

Follow-up

Refer to ARUP's HIV in Adults Testing algorithm

Human Immunodeficiency Virus (HIV) Combo Antigen/Antibody (HIV-1/O/2) by CIA, with Reflex to HIV-1 Antibody Confirmation by Western Blot 2006526

Test Description

4th generation qualitative screen simultaneously detects HIV-1 p24 antigen and antibodies to HIV types 1 and 2
- Antibody/antigen combination testing reduces diagnostic window by 5-7 days when compared to antibody-only assay

Reflex Pattern

If HIV-1, 2 combo antigen/antibody screen is repeatedly reactive, confirmation by western blot is added

Limitation

Does not distinguish between the presence of HIV-1 p24 antigen, HIV-1 antibody, and HIV-2 antibody

Follow-up

Refer to ARUP's HIV in Adults Testing algorithm

Human Immunodeficiency Virus (HIV) Combo Antigen/Antibody (HIV-1/O/2) by CIA, with Reflex to HIV-1/HIV-2 Antibody Differentiation, Supplemental 2013333

Test Description

4th generation qualitative screen simultaneously detects HIV-1 p24 antigen and antibodies to HIV 1 (groups M and O) and HIV-2
- Antibody/antigen combination testing reduces diagnostic window by 5-7 days when compared to antibody-only assay

Reflex Pattern

Repeatedly reactive HIV-1, 2 combo antigen/antibody screen will reflex to HIV-1/HIV-2 antibody differentiation

Limitation

Does not complete the 2014 CDC Recommended Algorithm for Laboratory Diagnosis of HIV Infections
Preferred test is Human Immunodeficiency Virus (HIV) Combo Antigen/Antibody (HIV-1/O/2) by CIA, Reflexive Panel 2012674

Follow-up

Refer to ARUP's HIV in Adults Testing algorithm

3rd Generation HIV-1, HIV-2 Antibody Screen

Human Immunodeficiency Virus Types 1 and 2 (HIV-1, HIV-2) Antibodies by CIA with Reflex to HIV-1 Antibody Confirmation by Western Blot 2005377

Also available – HIV-1-only antibody screen with western blot confirmation

Human Immunodeficiency Virus Type 1 (HIV-1) Antibody by CIA with Reflex to HIV-1 Antibody Confirmation by Western Blot 2005375

Test Description

Qualitative test detects antibodies to HIV types 1 and 2

Reflex Pattern

If HIV-1, 2 antibodies screen is repeatedly reactive, confirmation by western blot is added

Limitation

Not positive until 3-5 wks after exposure

Follow-up

Refer to ARUP's HIV in Adults Testing algorithm

Confirmation Tests Following Repeatedly Reactive 3rd or 4th Generation Test

Human Immunodeficiency Virus Types 1 and 2 (HIV-1/2) Antibody Differentiation, Supplemental, with Reflex to HIV-1 Quantitative PCR 2012669

Test Description

Useful as a supplemental assay for repeatedly reactive 3rd or 4th generation HIV screen tests when following the CDC HIV Diagnostic Algorithms

Limitation

Test cannot be used as a rapid screen, nor as a follow-up for a positive rapid screen

Follow-up

Refer to ARUP's HIV in Adults Testing algorithm

Human Immunodeficiency Virus Type 1 (HIV-1) Antibody Confirmation by Western Blot 0020284

Test Description

Use only when a specimen is repeatedly reactive for HIV-1 or HIV 1/2 antibodies

Limitation

Test cannot be used as a rapid screen

Follow-up

Refer to ARUP's HIV in Adults Testing algorithm

Human Immunodeficiency Virus Types 1 and 2 (HIV-1/2) Antibody Differentiation, Supplemental 2013107

Test Description

Discriminates between HIV-1 and HIV-2 antibodies
Use only when patient has a repeatedly reactive 3rd- or 4th-generation HIV screen test result

Limitation

Test cannot be used as a rapid screen

Follow-up

Refer to ARUP's HIV in Adults Testing algorithm

Follow-Up Testing for HIV Confirmation Test

HIV Quantitative PCR

Human Immunodeficiency Virus 1 by Quantitative PCR 0055598

Test Description

Quantitative test
May be ordered to detect acute HIV infection
Use to determine and monitor therapy in confirmed HIV cases

HIV Qualitative PCR

Human Immunodeficiency Virus 1 (HIV-1) by Qualitative PCR 0093061

Test Description

Qualitative test detects HIV-1 DNA and RNA in infants
For initially positive test, recommend repeat testing at 1-2 mos and 3-6 mos of age to confirm diagnosis

CD4 Lymphocyte Counts

Lymphocyte Subset Panel 1 – CD4 Absolute Count Only 0095854

Test Description

Quantitative test
Absolute CD4 count is sufficient for routine HIV monitoring
Order concurrently with HIV viral load testing for monitoring treatment and disease

^a All linked tests are offered by ARUP Laboratories

CIA, chemiluminescent immunoassay; PCR, polymerase chain reaction

Diagnosis

Indications for Testing

Refer to Key Points

Laboratory Testing

CDC revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings (2006)
Refer to
- Key Points for clinical symptoms, indications for testing, and available laboratory tests
- HIV testing algorithms
  - HIV Testing in Adults algorithm
  - HIV Testing in Infants algorithm
Refer to Human Immunodeficiency Virus 1, Antiretroviral Drug Resistance Testing for antiretroviral drugs genotyping analysis
- Resistance testing recommended for treatment-naive patients prior to initiating therapy and in all patients with treatment failure

Differential Diagnosis

Pharyngitis
- Streptococcal disease, group A
- Epstein-Barr virus
- Neisseria gonorrhoeae
- Head and neck cancer
- Viral pharyngitis
Flulike illness
AIDS-presenting infection
- Cytomegalovirus
- Herpes simplex virus
- Isospora belli
- Kaposi sarcoma
- Lymphoma
- Mycobacterium tuberculosis
- Pneumocystis jirovecii
- Toxoplasma gondii
- Disseminated fungal infection
  - Histoplasma
  - Coccidioides
  - Candidiasis

Screening

Refer to Key Points

Monitoring

Quantitative viral load – allows for monitoring during treatment
Drug resistance testing – allows for guided therapy decisions, particularly if patient response to therapy diminishes

Background

Epidemiology

Incidence – ~39,800 new HIV infections in 2016 in the U.S. (CDC, 2017)
Age – 25-34 years (peak) (CDC, 2017)
Sex – M>F
Ethnicity – higher in African Americans
Transmission
- Primarily via sexual contact (especially in men having sex with men)
- Bloodborne – not transmitted via saliva, insect vectors, or household contacts
- Perinatal
- Tissue transplantation
- Intravenous drug use

Organism

RNA single-stranded virus
Retroviridae family – includes HIV-1 and -2, and human T-cell lymphotropic virus types 1 and 2 (HTLV-1 and -2)
HIV-1 and HIV-2 are etiologic agents of AIDS
- HIV-1 accounts for the vast majority of HIV infections in the U.S.
  - Includes group M and at least 10 subtypes (A through J)
    - Group O (for outlier)
    - Group N (for non-M, non-O)
- HIV-2 is endemic in West Africa and rarely seen in U.S.
  - Includes groups A through E

Pathophysiology

HIV localizes to the lymphoid organs
- Infects the CD4+ helper cells and T-cell lymphocytes
Viremia ensues following infection
Viral spread from local inoculation occurs quickly
- ~30 billion virus particles produced in first weeks of infection

Clinical Presentation

Refer to Key Points

Prevention

Drug therapy during pregnancy, elective caesarian section, refraining from breastfeeding – 98% prevention rate in infants of infected mothers
Condoms
Needle exchange programs
Preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP)

ARUP Lab Tests

Tests generally appear in the order most useful for common clinical situations. Click on number for test-specific information in the ARUP Laboratory Test Directory.

Human Immunodeficiency Virus (HIV) Combo Antigen/Antibody (HIV-1/O/2) by CIA, Reflexive Panel 2012674
Method: Qualitative Chemiluminescent Immunoassay/Qualitative Immunoassay/Quantitative Polymerase Chain Reaction

Recommended Use

2014 CDC Recommended Algorithm for Laboratory Diagnosis of HIV infection

4th generation test screens for HIV-1 p24 antigen and antibodies to HIV-1 (groups M and O) and HIV-2

Reflex pattern – repeatedly reactive HIV-1, 2 antigen/antibody screening results are confirmed with an HIV-1/HIV-2 antibody differentiation test; negative or indeterminate results for HIV-1/2 antibody differentiation are confirmed with a quantitative polymerase chain reaction (PCR) test

Human Immunodeficiency Virus (HIV) Combo Antigen/Antibody (HIV-1/O/2) by CIA, with Reflex to HIV-1 Antibody Confirmation by Western Blot 2006526
Method: Qualitative Chemiluminescent Immunoassay /Qualitative Western Blot

Recommended Use

4th generation qualitative screen simultaneously detects HIV-1 p24 antigen and antibodies to HIV type 1 (groups M and O) and type 2

Reflex pattern – if the HIV-1, 2 combo antigen/antibodies screen is repeatedly reactive, then the HIV-1 antibody confirmation by western blot will be added

Limitations

Does not distinguish between the presence of HIV-1 p24 antigen, HIV-1 antibody, and HIV-2 antibody

Human Immunodeficiency Virus Types 1 and 2 (HIV-1, HIV-2) Antibodies by CIA with Reflex to HIV-1 Antibody Confirmation by Western Blot 2005377
Method: Qualitative Chemiluminescent Immunoassay/Qualitative Western Blot

Recommended Use

Screen for antibodies against HIV-1 and HIV-2

Reflex pattern – if HIV-1 and HIV-2 screen is repeatedly reactive, then HIV-1 antibody confirmation by western blot will be added

Human Immunodeficiency Virus Type 1 (HIV-1) Antibody by CIA with Reflex to HIV-1 Antibody Confirmation by Western Blot 2005375
Method: Qualitative Chemiluminescent Immunoassay/Qualitative Western Blot

Recommended Use

Screen for presence of HIV-1 infection if HIV-1/HIV-2 combined antibody testing not available

Reflex pattern – if HIV-1 antibody by CIA screen is repeatedly reactive, then HIV-1 antibody confirmation by western blot will be added

Human Immunodeficiency Virus Types 1 and 2 (HIV-1/2) Antibody Differentiation, Supplemental, with Reflex to HIV-1 Quantitative PCR 2012669
Method: Qualitative Immunoassay/Quantitative Polymerase Chain Reaction

Recommended Use

Useful as a supplemental assay for repeatedly reactive 3rd- or 4th-generation HIV screen tests, when following the CDC Proposed HIV Diagnostic Algorithm

Test discriminates between HIV-1 and HIV-2 antibodies; results for each type are reported

Reflex pattern – if the HIV-1/2 antibody differentiation immunoassay is negative or indeterminate, then the HIV-1 by quantitative PCR will be added

Limitations

Test cannot be used as a rapid screen, nor as a follow-up for a positive rapid screen

Human Immunodeficiency Virus Types 1 and 2 (HIV-1/2) Antibody Differentiation, Supplemental 2013107
Method: Qualitative Immunoassay

Recommended Use

Use only when patient has a repeatedly reactive 3rd- or 4th-generation HIV screen test result

Test discriminates between HIV-1 and HIV-2 antibodies

Human Immunodeficiency Virus Type 1 (HIV-1) Antibody Confirmation by Western Blot 0020284
Method: Qualitative Western Blot

Recommended Use

Order this assay only when a specimen is repeatedly reactive for HIV-1 or HIV-1/2 antibodies

Human Immunodeficiency Virus 1 by Quantitative PCR 0055598
Method: Quantitative Polymerase Chain Reaction

Recommended Use

Detect and quantify HIV-1

Limitations

"Not Detected" result does not rule out the presence of PCR inhibitors or HIV-1 virus RNA concentrations below the assay detection level

Human Immunodeficiency Virus 1 (HIV-1) by Qualitative PCR 0093061
Method: Qualitative Polymerase Chain Reaction

Recommended Use

Detect HIV-1 RNA and proviral DNA

Limitations

PCR may not detect infection in the first months of life

Lymphocyte Subset Panel 1 - CD4 Absolute Count Only 0095854
Method: Quantitative Flow Cytometry

Recommended Use

Aid in clinical management of HIV-positive individuals

Human Immunodeficiency Virus 1, Genotype by Sequencing 0055670
Method: Reverse Transcription Polymerase Chain Reaction/Sequencing

Recommended Use

HIV-1 genotyping provides antiretroviral susceptibility information for protease inhibitors (PIs) and reverse transcriptase inhibitors (NRTIs, NNRTIs)

Intended for patients with viral load >1,000 copies/mL

For more information, refer to ViroSeq HIV-1 Antiretroviral Drug Resistance Report

Limitations

Some insertions or deletions may be difficult to detect

Test does not detect HIV-1 populations <20% of the total population

Human Immunodeficiency Virus (HIV) Combo Antigen/Antibody (HIV-1/O/2) by CIA with Reflex to HIV-1/HIV-2 Antibody Differentiation, Supplemental 2013333
Method: Qualitative Chemiluminescent Immunoassay/Qualitative Immunoassay

Recommended Use

4th generation test screens for HIV-1 p24 antigen and antibodies to HIV-1 (groups M and O) and HIV-2

Reflex pattern – if the HIV-1, 2 combo antigen/antibody screen is repeatedly reactive, then the HIV-1/HIV-2 antibody differentiation test will be performed

Test does not complete the 2014 CDC Recommended Algorithm for Laboratory Diagnosis of HIV Infection; preferred test is HIV combo antigen/antibody (HIV-1/O/2) reflexive panel

Human Immunodeficiency Virus 1 (HIV-1) by Qualitative Transcription-Mediated Amplification (TMA) 2014234
Method: Qualitative Transcription-Mediated Amplification

Medical Reviewers

Hillyard, David R., MD, Medical Director, Molecular Infectious Diseases at ARUP Laboratories; Professor of Clinical Pathology, Adjunct Professor of Biology, University of Utah

Krautscheid, Patti, MS, LCGC, Genetic Counselor, Molecular Genetics and Special Genetics Laboratories at ARUP Laboratories

Reimer, Larry G., MD, Chief of Clinical Microbiology, Veteran's Affairs Medical Center; Professor of Medicine and Pathology, University of Utah

Slev, Patricia R., PhD, Laboratory Section Chief, Immunology, at ARUP Laboratories; Associate Professor of Clinical Pathology, University of Utah

Wittwer, Carl T., MD, PhD, Medical Director, Immunologic Flow Cytometry at ARUP Laboratories; Professor of Clinical Pathology, University of Utah

References

Guidelines

Moyer VA, U.S. Preventive Services Task Force*. Screening for HIV: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2013; 159(1): 51-60. PubMed
ACOG Committee Opinion no 596: Committee on Gynecologic Practice: Routine human immunodeficiency virus screening. Obstet Gynecol. 2014; 123(5): 1137-9. PubMed
M53-A - Criteria for Laboratory Testing and Diagnosis of Human Immunodeficiency Virus Infection; Approved Guideline. Clinical and Laboratory Standards Institute. Wayne, PA [Published: Jun 2011; Accessed: Feb 2018]
Branson B, Owen S, Wesolowski L, et al. Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations. Centers for Disease Control and Prevention. Atlanta, GA [Published: Jun 2014; Accessed: Feb 2018]
Qaseem A, Snow V, Shekelle P, Hopkins R, Owens DK, Clinical Efficacy Assessment Subcommittee, American College of Physicians. Screening for HIV in health care settings: a guidance statement from the American College of Physicians and HIV Medicine Association. Ann Intern Med. 2009; 150(2): 125-31. PubMed
Human Immunodeficiency Virus (HIV) Infection: Screening. U.S. Preventive Services Task Force. Rockville, MD [Published: Apr 2013; Accessed: Feb 2018]
Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015; 64(RR-03): 1-137. PubMed
Branson B, Handsfield H, Lampe M, Janssen R, Taylor A, Lyss S, Clark J. Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. 55(RR14);1-17. Centers for Disease Control and Prevention. Atlanta, GA [Last Reviewed: Sep 2006; Accessed: Feb 2018]

General References

Campbell-Yesufu OT, Gandhi RT. Update on human immunodeficiency virus (HIV)-2 infection. Clin Infect Dis. 2011; 52(6): 780-7. PubMed

Chu C, Selwyn PA. Diagnosis and initial management of acute HIV infection. Am Fam Physician. 2010; 81(10): 1239-44. PubMed

Cohen MS, Shaw GM, McMichael AJ, Haynes BF. Acute HIV-1 Infection. N Engl J Med. 2011; 364(20): 1943-54. PubMed

Cornett JK, Kirn TJ. Laboratory diagnosis of HIV in adults: a review of current methods. Clin Infect Dis. 2013; 57(5): 712-8. PubMed

d'Ettorre G, Zaffiri L, Ceccarelli G, Mastroianni CM, Vullo V. The role of HIV-DNA testing in clinical practice. New Microbiol. 2010; 33(1): 1-11. PubMed

O'Conell RJ, Peel SA. Multispot HIV-1/HIV-2 Rapid Test: advantages over other rapid HIV tests. Expert Rev Mol Diagn. 2007; 7(5): 499-505. PubMed

References from the ARUP Institute for Clinical and Experimental Pathology^®

Bedoya VI, Jaimes FA, Delgado JC, Rugeles C, Usuga X, Zapata W, Castaño ME, Boasso A, Shearer G, Rugeles MT. Fetal-maternal HLA-A and -B discordance is associated with placental RNase expression and anti-HIV-1 activity. Curr HIV Res. 2008; 6(4): 380-7. PubMed

Choi HH, Gray PB, Storer TW, Calof OM, Woodhouse L, Singh AB, Padero C, Mac RP, Sinha-Hikim I, Shen R, Dzekov J, Dzekov C, Kushnir MM, Rockwood AL, Meikle AW, Lee ML, Hays RD, Bhasin S. Effects of testosterone replacement in human immunodeficiency virus-infected women with weight loss. J Clin Endocrinol Metab. 2005; 90(3): 1531-41. PubMed

Ebbert MT, Mallory MA, Wilson AR, Dooley SK, Hillyard DR. Application of a new informatics tool for contamination screening in the HIV sequencing laboratory. J Clin Virol. 2013; 57(3): 249-53. PubMed

Lloyd IE, Clement PW, Salzman KL, Jensen RL, Salama ME, Palmer CA. An unusual and challenging case of HIV-associated primary CNS Lymphoma with Hodgkin-like morphology and HIV encephalitis. Diagn Pathol. 2015; 10: 152. PubMed

McCarthy MW, Genzen JR, Wilkin TJ, Singh HK. Use of a commercial HIV co-receptor tropism assay in clinical practice. AIDS Patient Care STDS. 2015; 29(2): 53-4. PubMed

Melis R, Lewis T, Millson A, Lyon E, McMillin GA, Slev PR, Swensen J. Copy number variation and incomplete linkage disequilibrium interfere with the HCP5 genotyping assay for abacavir hypersensitivity. Genet Test Mol Biomarkers. 2012; 16(9): 1111-4. PubMed

Pyne MT, Hackett J, Holzmayer V, Hillyard DR. Large-scale analysis of the prevalence and geographic distribution of HIV-1 non-B variants in the United States. J Clin Microbiol. 2013; 51(8): 2662-9. PubMed

Pyne MT, Konnick EQ, Phansalkar A, Hillyard DR. Evaluation of the Abbott investigational use only realtime HIV-1 assay and comparison to the Roche Amplicor HIV-1 monitor test, version 1.5. J Mol Diagn. 2009; 11(4): 347-54. PubMed

Pyne MT, Wilson A, Hillyard DR. Large-scale comparison of Roche Cobas AmpliPrep/Cobas TaqMan and Abbott RealTime HIV assays. J Virol Methods. 2012; 184(1-2): 106-8. PubMed

Rossi A, Couturier MR. The Brief Case: Cryptosporidiosis in a Severely Immunocompromised HIV Patient. J Clin Microbiol. 2016; 54(9): 2219-21. PubMed

Salama ME, Perkins SL, Mariappan R. Images in HIV/AIDS. Primary bone marrow presentation of Epstein-Barr virus-driven HIV-associated Hodgkin lymphoma. AIDS Read. 2007; 17(12): 604-5. PubMed

Taborda NA, Cataño JC, Delgado JC, Rugeles MT, Montoya CJ. Higher SLPI expression, lower immune activation, and increased frequency of immune cells in a cohort of Colombian HIV-1 controllers. J Acquir Immune Defic Syndr. 2012; 60(1): 12-9. PubMed

Wyness SP, Yee MA, La'ulu SL, Tosiello L, Straseski JA. Multiple macroenzymes in a patient with AIDS: diagnosis using ultrafiltration. Am J Clin Pathol. 2014; 142(2): 266-8. PubMed

Testing Algorithms

Human Immunodeficiency Virus in Adults Testing Algorithm

Read more about Human Immunodeficiency Virus in Adults Testing Algorithm

Human Immunodeficiency Virus in Infants Testing Algorithm

Read more about Human Immunodeficiency Virus in Infants Testing Algorithm

Immunodeficiency Evaluation for Chronic Infections in Adults and Older Children Testing Algorithm

Read more about Immunodeficiency Evaluation for Chronic Infections in Adults and Older Children Testing Algorithm

Immunodeficiency Evaluation for Chronic Infections in Infants and Children Testing Algorithm

Read more about Immunodeficiency Evaluation for Chronic Infections in Infants and Children Testing Algorithm

Content Review:

January 2017

Last Update: July 2018


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	Reimer L, Slev P. Human Immunodeficiency Virus - HIV. ARUP Consult^©. Retrieved July 19, 2018, from: https://arupconsult.com/content/human-immunodeficiency-virus

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Human Immunodeficiency Virus - HIV

Key Points

Diagnosis

Indications for Testing

Laboratory Testing

Differential Diagnosis

Screening

Monitoring

Background

Epidemiology

Organism

Pathophysiology

Clinical Presentation

Prevention

ARUP Lab Tests

Medical Reviewers

References

Guidelines

General References

References from the ARUP Institute for Clinical and Experimental Pathology®

Human Immunodeficiency Virus in Adults Testing Algorithm

Human Immunodeficiency Virus in Infants Testing Algorithm

Immunodeficiency Evaluation for Chronic Infections in Adults and Older Children Testing Algorithm

Immunodeficiency Evaluation for Chronic Infections in Infants and Children Testing Algorithm

References from the ARUP Institute for Clinical and Experimental Pathology^®