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ELISAGenerally referred to as ELISA (enzyme-linked immunosorbent assay) or, alternatively, EIA (enzyme immunoassay), these tests detect HIV antibodies, which the body starts producing between 2 and 12 weeks after becoming infected with HIV. Current HIV antibody tests can detect antibodies as early as 3 weeks after exposure, which is faster than the 1st generation of antibody tests. Current HIV antibody tests are often referred to as 2nd generation (detecting IgG antibodies), 3rd generation (detecting both IgM and IgG antibodies), and 4th generation (detecting both HIV antibody and the p24 antigen, which comes directly from the HIV virus). All positive HIV antibody test results should be confirmed with a Western blot, DNA PR Antigen Test or a Real Time HIV viral load test. Some HIV antibody tests will not detect HIV-2 (a strain of HIV that is found in western Africa) and some more uncommon strains of HIV-1. If HIV-2 infection is suspected, it is important to know whether the antibody test used is designed to detect both HIV-1 and HIV-2.
Rapid HIV TestUsing technology similar to that of an ELISA, a rapid test produces results in approximately 20 minutes. Two types of rapid tests are available now. One uses blood; in this case, a clinician pricks your finger with a small needle and takes a few drops of your blood. The other uses oral fluids and is very similar to the oral fluid test described above.
HIV Antibody Confirmation TestsThe ELISA test is designed to be highly sensitive, that is, to miss as few HIV infections as possible. The downside of the high sensitivity is that the ELISA may produce a small number of false-positive results. This usually is caused by the presence of antibodies to other diseases that the ELISA mistakenly recognizes as antibodies to HIV. For this reason, it is important to supplement both positive ELISA and rapid antibody results with a confirmatory test, such as a Western blot, that is less sensitive but more specific, that is, one that has a lower rate of yielding a false-positive result. Sometimes, a rapid antibody test is confirmed with a second rapid test from a different manufacturer.
Western BlotThe Western blot is the most common test used to confirm positive results from an ELISA or rapid HIV test. It generally is used only as a confirmatory test because it is difficult to perform and requires highly technical skills. Its advantage, however, is that it is less likely to give a false-positive result because it can more effectively distinguish HIV antibodies from other antibodies. However, the Western blot can yield inconclusive results in some samples.
Indirect Fluorescent Antibody (IFA)The indirect fluorescent antibody (IFA) test also detects antibodies made to fight an HIV infection. As with the Western blot, the IFA test is used to confirm the results of an ELISA. However, it is more expensive than a Western blot test.
HIV Viral Load MeasurementsYou will likely hear this test called a "viral load," "PCR," or "RNA" test. In the public health community, it is also referred to as HIV NAAT (nucleic acid amplification testing). The viral load test usually is used by clinicians to determine whether antiretroviral medications are working to suppress viral replication in HIV-infected persons taking medication. Unlike the previously mentioned HIV antibody tests, these types of tests detect the genetic material (RNA) of the virus rather than antibodies to HIV.
DNA PCR Antigen TestPCR stands for Polymerase Chain Reaction. PCR is a technique to look for unique DNA. PCR for the HIV virus looks for DNA of the HIV virus. PCR for the gene of cystic fibrosis looks for that DNA sequence unique for cystic fibrosis.
Detecting Very Early HIV InfectionThere is a window period with HIV infection, which refers to the time after a person has been infected but before an antibody test result will be positive. Testing for suspected early infections during the window period can be performed using HIV viral load tests or FDA-approved 4th-generation HIV antibody/antigen tests, which detect both HIV antibody and the p24 antigen, which is part of the HIV virus. These tests have the advantage of detecting early HIV infection before antibody development as well as antibodies that are present when chronic infection has been established. HIV viral load testing is also used to confirm infection in babies born to HIV-infected mothers, as antibody testing very early in a baby's life is not an accurate way to determine whether HIV infection has occurred in the infant.
Which Test Is Right for Me?In most cases you won't have much choice as to which type of test you receive. Before you get tested, you should understand the difference between an anonymous test and a confidential test. The differences are explained in What happens when you get tested for HIV? In many places, you cannot get an anonymous test, only a confidential test, so if getting an anonymous test is important to you, you will need to find a testing site that can provide one.