Frequently Asked Questions About HIV/AIDS (Part Two)
- What are the symptoms of AIDS?
- How long do I have to wait until I get tested for HIV?
- What is the approximate timeline of testing and symptoms for HIV/AIDS?
- When taking an antibody test, what does a negative, positive or indeterminate test result mean?
- How accurate are the home HIV tests?
- Should I get a PCR test or an antigen test?
I am making the following recommendations to persons concerned about symptoms that they may be having.
Carefully read all the information found on The Body's Safe Sex and Prevention Forum. It should answer the vast majority of questions regarding symptoms.
If you are having flu-like symptoms or a rash, I cannot tell you whether these may be due to acute viral syndrome (AVS) or not. Only HIV testing at three months after your possible exposure can determine whether a person has HIV.
If you are having any symptoms that are not going away after one to two weeks, or if your symptoms are very severe, see your physician, regardless of what you think the cause of your symptoms may be.
If you have been exposed to HIV, consider getting tested three months after a possible exposure to the virus. This is true whether you are having symptoms or not. This is the only way to know whether you have been infected with HIV.
Remember that I cannot tell you whether your symptoms may be due to HIV or not. Because every symptom associated with HIV/AIDS looks like the symptoms of other illnesses, I cannot tell you if your personal symptoms may be related to HIV/AIDS. Again, only HIV testing can determine that.
I have seen a lot of people convincing themselves that they may have AIDS, based on their symptoms. Many people have tried to "match their symptoms" to that of acute viral syndrome and AIDS. Please do not do this! It's very easy to convince yourself you have HIV/AIDS based on symptoms, when in fact you may not even be infected.
I have personally seen many cases where a person convinced themselves that they had HIV (based on their symptoms), went through major stress and anxiety (for months or even years), and then turned up HIV negative six months or more after the exposure that they were concerned about. I'm trying to keep other people from going through the same unnecessary mental torment.
The only thing that symptoms tell you is -- if they do not go away, or if they get very severe -- that you need to see a doctor. That's all they tell you. Please do not diagnose yourself based on symptoms!
You will also note that nobody, not you, me, or anybody on the Internet or at any HIV/AIDS hotline, can tell you if your symptoms may be HIV-related, without having laboratory tests done. [Click here to see a list of hotlines.]
That said, let me review with you the symptoms of HIV/AIDS in detail.
The following information compares the symptoms of both recent HIV infection, and the symptoms due to AIDS. You will note that the symptoms of HIV/AIDS itself tend to be chronic, long-term and can occur over and over. This differs from the symptoms of recent HIV/AIDS infection, which are acute, only last for a week or two, and do not occur over and over.
When we're talking about AIDS symptoms, it's important to remember that there are actually two periods of time when one may show symptoms.
Within the first four to six weeks after infection, some people with HIV (up to 70%) show symptoms due to what's called acute HIV syndrome or acute viral syndrome (AVS). This occurs during your bodies initial response against the virus. During this time, a person may show symptoms that look exactly like the flu (headaches, body aches, fevers, fatigue, etc.). These symptoms do not appear as cold symptoms (coughing, sneezing, congestion, runny nose, etc.).
A rash is sometimes seen, primarily in the upper portion of the body. The rash may or may not itch, and can be raised. There is no such thing as an "HIV/AIDS rash," and if a rash is seen at all, it resembles rashes seen from many other skin conditions. All of the symptoms last for a week or two, then go away by themselves. They do not persist for many weeks or months.
In some people with acute HIV infection, the symptoms can be very severe. In other people with HIV, these symptoms may be very mild. In still other people with HIV, they may not show these symptoms at all. A person may, or may not, show positive on an HIV test during this period of time. I must strongly emphasize here that all of the symptoms of acute HIV infection look exactly like the symptoms of other illnesses, so having flu symptoms or a rash does not indicate HIV infection, in of itself. It is also important to remember that not all people will get acute viral syndrome, and in those that do get it, the severity can vary significantly from person to person. Because acute infection looks exactly like the symptoms of many other illnesses, nobody can tell you whether or not your symptoms are due to this syndrome. Only HIV testing can determine if a person has HIV or not.
I have had a lot of people come to me concerned about acute infection, and exactly when it occurs. Can it happen in the first hour after an exposure? The first day? The first week? The first month? The first year?
Because the symptoms of acute infection are so non-specific, it's difficult for anybody to determine the exact time that this syndrome occurs. The fact is, nobody can give you an exact time, since it can vary from person to person.
Also remember that during this time, a person may or may not test positive. This makes it even more difficult to determine if symptoms are related to acute HIV infection or not. All anybody can say is that the symptoms occur within the first month or so (that is, within the first four to six weeks) after infection. The symptoms usually last for a week or two, although this, too, can vary from person to person. They do not however last for many weeks or months. And these symptoms do not occur in all people; the estimate is about 70% of people get this syndrome. That's all anybody can say.
How soon you get any symptoms after an exposure is unimportant and irrelevant. What is important is that if you've been exposed to the virus, that you get tested, regardless of whether you have symptoms or not. And if your symptoms are persistent or very severe, it's important that you see a physician, regardless of what you think the cause may be.
In regard to the symptoms related to advanced HIV or AIDS, they don't usually begin until literally years after infection. Before that time, a person can look and feel totally healthy with no symptoms at all. As for the specific symptoms of AIDS, there are none. This is because AIDS is actually a group of diseases, and therefore you're dealing with literally dozens of different symptoms. Not everyone with AIDS has every disease and therefore not everyone has every symptom.
Every symptom of AIDS looks like the symptoms of other illnesses. There are no symptoms that are unique to AIDS. Symptoms can include severe weight loss, fevers, drenching night sweats, fatigue, purple-colored blotches on the skin, severe headaches, severe diarrhea -- the list goes on and on.
Generally the symptoms tend to last for many weeks or months at a time, and do not go away by themselves (not without treatment). They can also recur over and over. Notice how this differs from the symptoms of acute HIV infection, which only lasts for a week or two, and does not recur over and over. AIDS symptoms are ongoing and can be very severe. AIDS-related symptoms do not begin until an average of 10 years after infection. You can have HIV and even full-blown AIDS and have no symptoms at all!
Generally speaking, if you have any symptoms that last for more than one to two weeks and do not go away, or if you have any symptoms that are very severe, always seek medical attention, regardless of what you think the problem is. You can't assume any symptom is HIV/AIDS related until you get laboratory tests. Remember, every symptom related to HIV/AIDS looks like the symptoms of other illnesses. Therefore symptoms alone cannot determine whether a person has HIV or not. Nobody can tell you whether or not your symptoms are due to HIV/AIDS, without getting tested. That's why laboratory testing is so important.
In regard to the accuracy of the antibody tests:
The average period of time that an infected person will show positive on the test is 25 days. This is an average, so not all people will test positive by this point in time.
The usual period of time that an infected person will show positive on the test is three months. This means that most (but not all) infected people will show positive on the test by this time.
The maximum period of time that an infected person will show positive on the test is six months. By this point in time, more than 99% of infected persons will show positive on the test. This is as accurate as any test in medicine could ever be.
For the absolute most accurate test result, you must wait six months after your last possible exposure to the virus (or anytime after that). At six months, the tests are more than 99% accurate. If you get tested before the six-month waiting period, it's possible (though rare) that you could have the infection but the test won't pick it up.
Times are approximate and may vary greatly from person to person. The following table is not drawn to scale.
|AVS||=||Acute viral syndrome|
|PCR||=||Polymerase chain reaction test|
|[----]||=||Appears for a limited time only|
|[---->||=||May continue for long periods of time|
|*||=||These tests may not always show a positive result in an infected person! Therefore, these tests should not be used for the diagnosis of HIV in routine testing of adults.|
|**||=||Symptoms may not always be present, and the severity of symptoms may vary greatly from person to person. The average time that the symptoms of full-blown AIDS begins is 10 years.|
When a person gets an antibody test for HIV, the first test that is done is the ELISA test, also called the EIA. If the ELISA test is negative, this is considered a negative result, and confirmatory tests are not necessary. A negative result means that no antibodies were found.
If the ELISA test is repeatedly positive, it must be confirmed with a confirmatory test (usually a Western Blot or an IFA test). This second test can be done from the same tube of blood. You must test positive on both the ELISA test and the confirmatory test, to be considered HIV positive. If both the ELISA test and the confirmatory test are positive, this is considered a positive result. This means that antibodies were found, and the person is infected with HIV.
If the ELISA test is repeatedly positive but the confirmatory test is negative, this is considered a negative result overall, and this means that no antibodies were found.
ELISA tests are either positive or negative. Western Blot tests however, can be positive, negative or indeterminate. An indeterminate test means that the test could not determine whether a person is infected or not. This can be due to two things. Either a person was so recently infected that they are just starting to produce antibodies, or something else is cross-reacting on the test. If an indeterminate test result occurs, the person is usually re-tested in four to six weeks to determine whether they are infected or not.
The ELISA test is very good at picking up infections, but sometimes gives false positive readings (which is why confirmatory testing is always done on positive ELISA results). The Western Blot is very good at ruling out false-positive ELISA tests.
Home HIV tests are as accurate as the antibody tests done in doctors' offices and health departments, and they use the same ELISA/Western Blot/IFA tests. Like other antibody tests, these tests are subject to the same six-month waiting period in order for the tests to be fully accurate.
There are certain pros and cons to using home testing kits.
A person who's scared about being seen in a clinic can do the test without anyone knowing about it outside their home. They may feel more comfortable doing the test alone.
These tests can be ordered by phone or on the Internet, and can be an option for those who do not have transportation to local clinics, or who are home-bound due to disabilities.
The test itself is as accurate as antibody tests commonly used in clinics around the country.
Dealing with test results over the phone can be very difficult, especially if the test was positive. A person can just hang up and never hear all the counseling and information they need to hear. Test counseling is best done face-to-face, and is most effective this way.
Using home testing, if a person is positive, there is no way to do partner notification (helping a person's sex/needle-sharing partners know they've been exposed). Partner notification is routinely done by local health departments around the country for HIV and other STDs. Home testing would bypass this important, and proven, preventive health measure.
Home testing is also more expensive. Testing through local health departments, and some private agencies, is free or low cost. Home test kits can cost $30 to $50.
Another issue to be dealt with is confidentiality. If a person buys a home test kit in a store, everyone in the store will know that person is taking an HIV test. The most confidential way to purchase the kit is by phone or through the Internet. Also, when taking a test at home, all the packaging for the kit has to be well hidden in the garbage. If a garbage man empties your garbage, and sees the test kit packaging in the garbage, they'll know you took an HIV test. If your garbage can were to open up (from animals, wind, etc.) your neighbors could know you've been tested for HIV as well. So for persons taking the home test, I say "Hide Your Garbage!"
In a home test kit, a person has a test ID card that is used to identify the specimen. Anyone who has the number can get the test result over the phone. The person who is being tested has to make sure that nobody sees the card. Otherwise, any person who sees the card or the number can get that other person's test results. So it's important that a person getting tested at home doesn't leave the ID number lying around the house, where other members of the household can see it.
In the United States, there is presently only one home test kit, Home Access, that has been approved by the U.S. Food and Drug Administration (FDA). There was previously another FDA-approved home test called Confide, but this is no longer being sold, and has been discontinued. The Home Access home HIV test has been proven to be safe to use and accurate. Unfortunately, there are also unapproved home HIV tests being sold illegally, especially over the Internet. The accuracy and safety of these unapproved tests is unknown. Therefore, if you are using a home test kit other than Home Access, I cannot tell you whether these tests are safe or accurate. Like anything else you buy (especially over the Internet), as the saying goes, "Let the buyer beware!"
I personally have tried Home Access. Since I live in a rural community in the United States, I had to be very careful regarding confidentiality, especially as it came to hiding my garbage. Also, I can see some people having difficulty in doing a fingerstick to draw blood for the test. The test itself takes about an hour to do (which includes time for the specimen to dry and to package up the sample to send to the lab). It also includes a lot of reading material for the person to read through. I therefore recommend about two hours to do the test at home. This includes all the time to read the materials, and to do the actual test.
Home testing is an option for those who prefer to do the test on their own without having to go through a doctor or a clinic. It is up to you to decide which option is best for you. I chose to take the test at home, so I would gain a personal insight as to what that was like.
The subject of PCR tests is a very confusing one for many people. Unfortunately, these tests have needlessly been done on many people, and have needlessly contributed to an increase in health-care costs. These tests have their legitimate purposes, as described below, but they are not designed just to make people happy who don't want to wait six months for an antibody test. Taking expensive tests like PCR tests, only needlessly increases our health-care costs even more, thereby further limiting our already limited health-care resources. Expensive tests (like PCR tests) should not be done just to make people happy. They should only be done if there is a legitimate clinical need for these tests.
The DNA qualitative PCR test can be used for diagnostic purposes, but there are limitations to its use. Although it can often pick up an infection after about a month after an exposure, it will not always detect the infection. It is not designed to do routine screening in adults. It is used primarily for:
- Research applications, where the test can be repeated multiple times to rule out inaccuracies
- Testing in newborns less than 18 months of age where antibody tests are not reliable
- Testing in persons with other diseases of the immune system where antibody tests may not be reliable
- Other unusual circumstances
When we do qualitative diagnostic PCRs, we often do them more than once, just in case the first one did not accurately pick up the infection. We very rarely do just one PCR. We usually do more than one under most circumstances (especially in babies). PCR tests are also usually done in conjunction with other tests for HIV, just to rule out inaccuracies in the test.
This test is very difficult for labs to perform, hence its high cost. The more difficult the test, the greater the chance of inaccuracy. But it's a great test for labs that have a lot of experience with it. Usually only regional reference labs will do this test, but not the vast majority of clinical labs.
Many people have requested these tests, since they don't want to wait six months to take an antibody test. Doing these tests is clinically not necessary in the vast majority of these cases, and only needlessly increases our health care costs (these tests cost several hundred dollars). In the vast majority of cases, antibody tests are all an adult needs. If a person can't cope with the six-month waiting period for antibody testing, counseling is often a better option than PCR testing.
The following is a summary statement about PCR testing that was recently published in a research journal. It states:
"The PCR assay is not sufficiently accurate to be used for the diagnosis of HIV infection without confirmation. Use of PCR for the diagnosis of HIV in adults should be limited to situations in which antibody tests are known to be insufficient. Future studies of PCR performance should be sufficiently large and should use adequate reference standard tests and standardized methods for the performance of PCR. Specimens should be evaluated by persons blinded to clinical status and to the results of other diagnostic tests for HIV infection."
The p-24 antigen test will pick up an infection an average of six days prior to a person testing antibody positive. The p-24 antigen tests will often show positive two to three weeks after initial infection. However, not all recently infected persons have detectable levels of p-24 antigen in their blood.
So a negative p-24 antigen test does not necessarily mean a person is not infected. Once the person turns antibody positive, the p-24 antigen test will often revert back to a negative result. So this test will only be positive for a short period of time.
Let me also stress that the p-24 antigen test alone cannot be used to diagnose HIV infection. Remember, this test will not always pick up an infection. A p-24 antigen test (whether positive or negative) must always be used alongside other HIV diagnostic tests, before a person's HIV status can be determined.
Do you want more information on HIV/AIDS, STDs or safer sex? Contact the U.S. Centers for Disease Control Health Line, open 24 hours a day, seven days a week, at 1-800-232-4636. Or visit The Body's Safe Sex and Prevention Forum.
Until next time . . . Work hard, play hard, play safe, stay sober!