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HIV Testing: Firm Foundations in HIV Screening, Prevention, and Treatment
CME/CE Information

Activity

Progress
1 2 3
Course Completed
Activity Information

Pharmacists: 0.25 contact hour (0.025 CEUs)

Physicians: maximum of 0.25 AMA PRA Category 1 Credit™

Nurse Practitioners/Nurses: 0.25 Nursing contact hour

Released: January 08, 2026

Expiration: January 07, 2027

Joyce L. Jones
Joyce L. Jones, MD, MS

HIV Testing: Firm Foundations in HIV Screening, Prevention, and Treatment      

 

[00:00:14]

 

Dr. Joyce Jones (Johns Hopkins University School of Medicine): Hello. Thank you for joining. Today I'm going to be speaking about HIV testing, HIV screening, prevention, and treatment. I'm Joyce Jones. I'm an assistant professor of medicine at the Division of Infectious diseases at the Johns Hopkins University School of Medicine in Baltimore, Maryland.

 

[00:00:55]

 

Faculty

 

And I have no relevant financial relationships to disclose.

 

[00:01:00]

 

Learning Objective

 

So our learning objective today is to apply CDC recommendations for HIV testing across clinical settings.

 

[00:01:10]

 

Patient Case 1         

 

We're going to start with a case. So a 20 year old - 20 year old woman presents to you for her annual health visit. She reports that she is sexually active with her boyfriend for the last year. She has no other past medical history, and she reports that she has never been tested for HIV.

 

[00:01:34]

 

How to Implement Routine HIV Screening

 

So routine HIV screening is a CDC recommendation, and the recommendation is for opt-out testing. What that means is that all patients between the ages of 13 and 64 should be tested for HIV at least once, as part of their routine health care. They should be notified that they're being HIV tested, but they do not need to ask for the HIV test.

 

All pregnant patients, regardless of age, it's also recommended that they get tested. And then in terms of repeat testing, people who may have an ongoing risk for HIV infection should be screened at least once annually. And the reasons we want to do this are to reduce the stigma related to HIV. People may be concerned that they have HIV infection, but because of stigma associated with HIV, they feel uncomfortable asking for the test.

 

It makes HIV testing a normal part of healthcare and of appropriate screening for different - different conditions. It leads to earlier diagnosis and treatment of HIV for people who do have HIV infection, and it prevents missing people who have HIV because of a - of biases held by the provider. So will that person, they couldn't have HIV. It takes that bias out of the equation for HIV testing.

 

[00:03:46]

 

What Tests To Use   

 

And - and then we're going to talk about what types of tests. So depending on what test you order, there are different ways that the test can be performed. There are point-of-care tests, which are tests that are performed right there in the clinical setting. And you have a result within about 20 minutes. There are laboratory-based strategies which are more accurate where you're collecting a specimen, and then you're sending it to a lab for processing and to get the result. And then there's also an option of home-based testing, where people can conduct the test themselves at home.

 

[00:04:59]

 

CDC Recommendations for HIV Testing

 

So in terms of the CDC algorithm for HIV testing, the best test to start with for screening people for HIV is the HIV antigen antibody combination immunoassay. And this HIV test can - can detect HIV-1 and HIV-2. And it detects for the HIV antigen along with the HIV antibody. If that test is positive, then a confirmatory test needs to be conducted. And that would be the antibody test. And that is a test that can not only confirm HIV infection, but also it can distinguish between whether or not the infection is HIV-1 or HIV-2. In the United States, HIV-1 is the predominant type of HIV that people newly diagnosed have.

 

If the antigen - if the differentiation immunoassay is indeterminate, then or - then you should - next step would be to get a HIV nucleic acid amplification test. And that's a test that's looking for the HIV RNA specifically. And that will then indicate sometimes people are early in the course of HIV infection, and so the test is indeterminate. And then so you do a third test that looks for the HIV virus itself. And if that's positive, then that indicates the person has acute or early HIV infection. And if it's negative with that indeterminate test, it indicates they do not have HIV infection.

 

Back at the top, If you're doing that initial screening test, the antigen antibody combination immunoassay test. And if that's negative, the person is considered negative for HIV infection. You also potentially - if you suspect somebody may have acute HIV infection, so they have risk factors for HIV. They have signs and symptoms of acute HIV infection, like flu-like syndrome, then you may - even if their initial screening test, the antigen antibody test is negative, you may want to still get the HIV-1 nucleic acid amplification test.

 

[00:07:40]

 

Types of HIV Tests

 

Okay. So now I'm going to go a little bit more into each of the different types of tests. When we're doing an antibody test, it is looking for the immune system's response to infection. So it's detecting immunoglobulins antibodies, the - against HIV. This is the test that was the oldest kind of test that we had. It is the test that we use to confirm that a person has HIV infection. And this is the test that is most readily available. It is again, what we use as - I'm going to pause because of the sirens, and I'll just restart. I don't know how much you can hear now. Okay, that may happen frequently. I'm at the hospital, so.

 

So this slide shows us the different types of HIV tests that are available. There's the antibody test, which is the first test that was developed to detect HIV. This test looks for antibodies that the immune system makes against HIV infection. And this test is the test that we use to confirm that somebody has HIV. It's available to be conducted in the laboratory. It's the most common test that we have as point of care. So when we're in the clinic, and we do a test, and we get a result back within about 20 minutes.

 

It's usually an antibody test. It's also available as a home-based test where somebody can go to a pharmacy, pick up a test. They do an oral swab, and then they can get their result right then and there, similar to a pregnancy test or a home-based COVID or flu test. They can see the result themselves at home. And then there's home-based collection of a specimen, like through whole blood, finger stick, dried blood spot, that then gets mailed into the laboratory, and then the testing is done in the lab, and then the result is sent back to the patient.

 

And again, if the antibody test is done at home, the reactive results require confirmatory testing. And then any time people have one HIV test that's done, we want to confirm it with a second test. So if somebody has an antibody test that's positive, we would likely then go to an HIV RNA test. The antigen antibody test is the most - it's the recommended test for HIV screening. And that detects not just the HIV antibodies, but it also detects the p24 antigen of the HIV virus itself. This test is available through sending a specimen to the lab.

 

It can be available as a point of care test as well for clinical settings, and again through dried blood spot home collection sent into the lab. This test can be performed that way. And again, if this test is positive, then it requires confirmatory testing. And then finally, there's a nucleic acid test, HIV RNA PCR test that's looking for the - the HIV virus itself. It detects the HIV RNA. It's a laboratory-based.

 

There are some point-of-care tests that are being developed. And again, if somebody tests positive for HIV through the antigen and or antibody test, you want to get a viral load result to measure the amount of virus in the blood. There's also diagnostic HIV RNA tests that have been FDA-approved for diagnosis of HIV as well. And again, if you suspect somebody has acute HIV infection typically we would do one of these other tests, the antigen antibody test or antibody only test, but even if that's negative, but you suspect acute HIV, then doing an HIV RNA test is the right next step.

 

[00:12:59]

 

Timing for HIV Test Positivity: The "Window" Period

 

These tests are able to detect HIV at different periods of time after a person has developed HIV infection. So the antibody test is the test as I mentioned that was the first developed to detect HIV. And that's detecting the immune system's response to fight the HIV infection. That antibody response takes some time to develop. And then the level of antibody that the tests can then detect an HIV antibody.

 

It takes about 23 to 90 days after a person is infected with HIV to have that antibody test become positive. So this is a test that we've been able to develop for home based testing for point of care testing, which is great but we may miss infection that has - we may miss infection that has not yet had time to develop those antibodies. That's the - that's the tradeoff. It is used to confirm HIV infection. So it is a good specific test, specific for HIV, but - but detecting HIV early, it - it can miss some of those people with early HIV infection.

 

And that is why the antigen-antibody test is the preferred test. So because it's detecting not only HIV antibody and it's detecting the p24 antigen, that p24 antigen, as you can see from this slide, is detectable earlier in the course of infection. And so the lab-based test is the most accurate test. And that can become positive within 18 to 45 days after infection, and the rapid point-of-care test 18 to 90 days.

 

And then the nucleic acid test, the HIV RNA PCR tests that can become positive as soon as 20 days after HIV infection. And so these ranges indicate the range of time until a test may become positive. For - so for some people, the antibody test can become positive as soon as 23 days. For other people, it may take up to 90 days for the test to become positive. So this is giving you the range of, you know, sort of earliest to latest, typically for people to have each of these different kinds of tests be positive after infection.

 

[00:17:58]

 

HIV Testing Is Important In Nearly All Healthcare Setting

 

So why is HIV testing important, and where is it important to conduct? So it's important to be available to people in pretty much every healthcare setting. And this is because we know that about 40% of new HIV infections occur from people who have HIV, but they don't know that they have HIV infection. Studies have shown that more than 75% of people who saw their primary care physician in the last year were not offered an HIV test. And again, in terms of who we think may have HIV or not, introduces a bias that takes away from identifying people who have HIV but are not people that in general are stereotypes of people who have HIV infection.

 

So things to consider in terms of risk for HIV include the HIV risk behaviors of the person themselves, but also potentially the behaviors of their sex partners, and also people may be engaging in behaviors that they're not comfortable sharing with their healthcare providers, such as injection, drug use, and different kinds of sex behaviors. Mainly because, again, of that stigma. All of us really should be comfortable offering HIV testing. The - the tests are very easy to perform, and it's important that we offer all of our patients the opportunity, if they have HIV infection to get treatment, and if they're HIV negative, but could benefit from prevention from having access to those really important interventions.

 

[00:20:10]

 

HIV Testing Should be Integrated into Multiple Healthcare Touchpoints

 

So there are many touchpoints at which HIV testing should be offered, not just HIV or infectious diseases specialists. So emergency departments, there are many people who don't access primary care, and the emergency department is their main source of - of care. Urgent care also is a place where many people who otherwise are not really engaging in the healthcare system do receive care. People working in addiction medicine. So people who work with people who use drugs should be comfortable doing HIV testing again, reproductive health, caring for people who are pregnant or want to become pregnant, or want to prevent pregnancy that is an important place for HIV testing to be offered. And then clearly primary care, it's an essential part of primary care, just like any of the other screenings that we offer in primary care settings.

 

[00:21:22]

 

Status-neutral HIV linkage

 

And when we're doing HIV testing because of, again, all of the advances that we've made in terms of HIV treatment and HIV prevention, we want to have HIV testing offered in all of these settings. And then we want to offer interventions for people who have HIV, and then also for people who are HIV negative but are at risk for HIV. This is called a status-neutral approach to linkage to care. And so again, this is really important to provide access to and information about all of these interventions that have been proven to be very effective. Our goal is to optimize health for people regardless of the HIV test result.

 

And we as providers, can continually reassess the clinical and social needs of people who are presenting for HIV testing. And again, if people are positive for HIV, rapidly connecting them with HIV treatment, people who are HIV negative to HIV prevention. And then as well as focusing on the medical interventions, the support for social determinants of health and other factors that may impede linkage to care. That's the status-neutral approach.

 

[00:22:54]

 

[00:25:01]

 

Key Points: HIV Testing

 

So the key points - I'd like you to take away from this module are that universal opt-out testing. So, conducting the tests, letting people know that you're performing the test, they can opt out of it, but making it routine decreases barriers and stigma to testing. I've shown you several different options for HIV testing.

 

The laboratory-based tests are the most accurate but rapid tests are very beneficial to - for the patient and the provider to have a result the same day. And then home-based tests are a great option for people who want to know their status it, you know, is convenient for them to do it at home. And they may be feeling some stigma about asking for even having the test conducted in a healthcare setting.

 

Remember that there are different windows for when those tests will be positive. And that's important in terms of counseling. And for - for people to know about when was their last potential exposure to HIV infection and then which test you're doing. And then what is that sort of window period when they may actually have infection, but it's not detected through that test. That's important to consider along with any symptoms people may have. So again, people who have acute or early HIV infection, it may take some time. It does take some time for different tests to be able to detect HIV. And so if you're suspicious of acute HIV infection, then making sure you're doing that HIV RNA test as part of the testing algorithm. And again, HIV testing should be part of routine care and integrated into diverse areas of health care.

 

[00:27:06]

 

Go Online for More CCO Coverage of HIV!

 

Thank you for participating in - in this module and for your interest in HIV screening, prevention, and treatment.