HIV Testing Blog

Scientists from across the world have done research on what appears to be a promising addition to the different forms of HIV Anti-retroviral therapy.

Human Immunodeficiency Virus, or HIV, is the virus that causes AIDS, and is at the forefront of research in many fields.  One of the most interesting topics of research is anti-retroviral therapy (ART) implemented in HIV positive patients in order to reduce the effect of the virus.

The newest breakthrough entails using snake and insect venom as a form of ART. A major component in bee venom inhibits replication of both CXCR4 and CCR5 HIV-1 in human CD4 cells. Phospholipase A₂ (PLA₂), which is found in the venom of many snakes, has been shown to block viral entry into cells.

The exact mechanism, whether enzymatic or simply competing for a binding site, is still in the process of being worked out.  Aside from this, the most important details have shown promising signs for the field of research dedicated to HIV treatment.

This discussion further reiterates the needs and necessity for regular, comprehensive STD testing.  If everybody got tested for STDs on a regular basis, the incidence of HIV (among other STDs) would be considerably lower.  Testing is simple, and should be done (as according to the CDC) every six months to one year, or in between sexual partners.

For the complete article, please refer to the original articles page.

The human immunodeficiency virus (HIV) is a retrovirus that causes acquired immune deficiency syndrome (AIDS). HIV can be transmitted through the exchanging of bodily fluids including blood, semen, vaginal discharge, and breast milk. Means of transmission include sexual contact with an infected person, sharing of needles or syringes with an infected person, or through blood transfusions with infected blood. Low quantities of HIV has been found in the saliva and tears of some AIDS patients; however, contact with saliva or tears has never resulted in an HIV transmission.

Healthcare workers are often exposed to the virus at work; however, it is unlikely that they will contract the virus from a patient. Since December 2001, there have been only 57 documented reports of patient-to-worker HIV transmission, mainly due to precautionary guidelines that healthcare workers follow. The main risk of transmission for healthcare workers  is through accidental needle sticks or other injury with a contaminated instrument. However, even here the risk is small. “Researchers estimate that only about 0.0-1% or healthcare workers” contract HIV from an accidental needle stick.

This low statistic can be attributed to post-exposure prophylaxis (PEP), which can be taken immediately after exposure to reduce the risk of transmission. PEP uses antiretroviral therapy (ART) to prevent transmission, but often comes with serious side effects including dizziness, fatigue, nausea, vomiting, diarrhea and more. Current antiretroviral drugs cannot cure HIV infection, nor reduce the risk of transmitting it to someone else, but they can suppress the virus to undetectable levels in some cases. It has been estimated that PEP reduces the infection rate among healthcare workers by 79%.

Post-exposure Prophylaxis should begin immediately after the exposure, seeing as how PEP is most effective when it is initiated within two t0 four hours of exposure. The specific dosage of medication depends on a couple factors including the patient’s overall health, the severity of exposure, the availability of antiretrovirals, and if the patient has any known or possible cross-resistance to any drugs. Treatment normally lasts no less than two weeks and no longer than four. Studies show that almost a quarter of those receiving PEP stop taking the medications early because of side effects. As with all forms of treatment, it is less effective if it ends early.

HIV tests should be performed after any risky sexual behavior, even if PEP was used. Immediately after HIV enters the body antibodies are produced to fight off the infection. While these antibodies cannot completely eliminate the virus, we can use their presence to see if HIV is in the blood. Most people develop detectable antibodies within two to eight weeks; however, it may take longer in some people. Most often, the enzyme immunoassay (EIA) test is used to detect HIV antibodies. If a positive result is returned it is confirmed with a follow-up test before making a diagnosis. Typically the Western blot test is used to confirm a positive HIV result. Other testing options include DNA or RNA tests, which instead of looking for antibodies actually look for genetic material of HIV. These tests can be used for early detection of HIV.

With the combination of healthcare precautions and treatment options such as PEP, we have the ability to decrease the number of patient to worker HIV transmissions drastically.

*For the complete article please refer to http://hivtestingblog.com/original-articles/

MAJOR RECOMMENDATIONS

Responsibilities of Child Healthcare Providers

As part of the initial newborn evaluation, the pediatric clinician should determine whether human immunodeficiency virus (HIV) testing of the mother has been completed properly and should follow up on any outstanding laboratory values.

Pediatric clinicians should obtain testing for HIV beyond the neonatal period if the child presents with signs and symptoms of HIV disease. Testing should be performed in children who have not yet been tested when risk factors for HIV infection exist in the child or one of his/her parents.

Laboratory Tests for HIV in Newborns, Children, and Adolescents

Because positive antibody results alone do not establish infection in children younger than 18 months of age, assays to detect virus (HIV deoxyribonucleic acid [DNA] polymerase chain reaction [PCR] or viral culture) should be used for diagnosis (see Figure 1 in the original guideline document).

In children older than 18 months of age, HIV infection may be diagnosed on the basis of a positive HIV antibody test (enzyme-linked immunosorbent assay [ELISA]) and a confirmatory test, such as Western blot.

Because of the time period between infection and the development of detectable antibodies, children/adolescents exposed via sexual activity, sexual abuse/assault, or infected blood who have an initial negative test result should be retested at 1 month, 3 months, and 6 months after exposure.

Because a child with end-stage HIV disease may become HIV-antibody seronegative as a result of severe humoral immunodeficiency, children who are clinically suspected to be HIV-infected yet test HIV antibody negative should be tested by DNA PCR (or HIV culture).

Children older than 18 months of age with an indeterminate Western blot result should be retested as soon as possible. If the Western blot result remains indeterminate, the patient should be tested for HIV-2 or specific viral tests (e.g., DNA PCR) for HIV-1 should be performed.

Rapid testing and expedited preliminary test results prior to Western blot confirmation should generally be used only when immediate information is needed to determine the need for post-exposure prophylaxis in the labor/delivery, newborn, or other acute exposure settings, or when the person who is being tested is unlikely to return for a follow-up visit.

When preliminary diagnostic tests are used for expedited HIV testing, a preliminary positive test result must be confirmed with a Western blot as soon as possible.

Testing for HIV Antibody

See the original guideline document for discussions of screening tests, confirmatory testing of positive results, and rapid test assays.

Testing for HIV or Viral Components

Clinicians should test children younger than 18 months of age who are born to an HIV-infected mother for HIV using one of the following methods:

* HIV DNA PCR (preferred method)

* HIV culture (acceptable method)

Because infection can only be confirmed with two positive test results performed on samples collected at different times, a repeat sample should be obtained promptly for any child with a single positive test result.

In an infant younger than 18 months of age, HIV can be reasonably excluded with two negative HIV viral tests, one at 1 month of age or older, and the other at age 4 months or older.

Ideally, a DNA PCR should be obtained for HIV-exposed infants at each of the following time points:

* at birth

* at 2 weeks of age

* at 4 to 6 weeks of age

* at 6 to 12 weeks of age

* at 4 to 6 months of age

See the original guideline for discussions of HIV DNA PCR, HIV culture, plasma HIV RNA, and HIV antigen detection.

HIV Counseling and Testing

In New York State, written informed consent from the child’s biological parent or legal guardian must be obtained before HIV testing can be performed in children except in certain specific circumstances, such as expedited testing, newborn screening, and follow-up PCR testing, and when testing is urgently necessary to provide medical care for a life-threatening condition.

When HIV testing of a child is performed, the parents should be considered for testing as well.

If a child is found to be perinatally HIV infected, his/her siblings also should be tested.

If HIV infection is newly diagnosed in a woman, all of her children should be strongly considered for testing, even if they are asymptomatic.

Pre-Test Counseling

The clinician should counsel the child’s parent or guardian or the child/adolescent with capacity to consent prior to HIV testing (see Table 2 in the original guideline document).

In New York State, a minor’s right to consent for or refuse HIV testing is based on his/her capacity to understand, without regard to chronological age, what an HIV antibody test actually tests for, the implications/consequences of being HIV infected, and why he/she is at risk for HIV.

The clinician should arrange for follow-up visits at the time of testing and should note in the patient’s medical record that counseling was provided and written consent was obtained when required.

When rapid testing is obtained and will yield a preliminary result during the visit, the clinician should first ensure that the patient/parent is emotionally able to receive a positive result and that mental health services are available for patients receiving a positive result.

Obtaining Consent

See the original guideline document for a discussion New York State laws on obtaining consent for HIV testing in children and adolescents for HIV testing.

Post-test Counseling

Counseling after a Patient Receives a Positive Test Result

Positive HIV test results should be presented in person to the appropriate individual (patient, parent, or guardian). A clinician should not communicate results to a patient or family member by telephone or mail.

Clinicians must respect an adolescent’s right to confidentiality concerning HIV status.

The clinician should explain the test results and should provide general information about available treatment.

The clinician should discuss the implications of the HIV Reporting/Partner Notification law (refer to the section “HIV Reporting and Partner Notification” below).

The clinician should provide or arrange for necessary referrals for treatment and supportive services.

The clinician should discuss methods of risk reduction and advise the family to inform medical personnel of the child’s HIV status during any medical care visit.

Counseling After the Patient Receives a Negative Test Result

When telling a patient that his/her test result is negative, the clinician should educate the patient on how to reduce the risk of transmission in the future.

HIV Reporting and Partner Notification

Since June 2000, New York State has required HIV reporting and partner notification for all confirmed positive HIV tests (unless testing occurred at an anonymous site) and HIV-related tests.

During pre-test counseling, parents/children should be informed that if their HIV test result is positive, their names will be reported to the New York State Department of Health.

Parents/children should be informed during pre-test counseling that if they provide the names of sexual or needle-sharing partners, the provider is required to report these names to the State Health Department. They should also be informed that if the test results are positive, their partners will be notified that they have been exposed to HIV.

All sexually active HIV-infected adolescents should be informed about the importance and benefits of notifying partners of their possible exposure to HIV.

Adolescents who are undergoing HIV testing should be questioned regarding the potential for domestic violence if their partners were notified. If domestic violence is a concern, partner notification should be deferred until the risk of harm to the patient (or one close to the patient, e.g., child) is eliminated.

HIV Testing of Older Children and Adolescents With the Capacity to Consent

Clinicians should be knowledgeable about New York State laws pertaining to adolescent consent and confidentiality and should educate their patients about these laws (see the National Guideline Clearinghouse (NGC) summary of the New State Department of Health guideline Identification and Ambulatory Care of HIV-exposed and -infected Adolescents).

In New York State, older children and adolescents who are judged capable of understanding the informed consent process may give written informed consent for HIV testing.

Parents cannot be informed of their child’s HIV test results without the explicit consent of the child or adolescent who is deemed capable of providing consent.

Ideally, HIV testing of older children and adolescents should occur in a comprehensive care setting that provides social support, ancillary services, and ongoing health care.

HIV Testing in Children in Foster Care

Within 5 days of entering the foster care system, all children must be assessed for capacity to consent for HIV testing. If a child is determined not to have capacity to consent, an HIV risk assessment must also be completed within the first 5 days of entering foster care. Children already in foster care must be assessed for HIV risk factors at least 60 days prior to their next scheduled periodic medical examination. If it is determined that a child may have the capacity to consent, an assessment of capacity to consent must be made and documented by authorized foster care agency staff within 30 days of the child’s entry into foster care. An HIV risk assessment must also be completed within this timeframe.

If one or more risk factors are present, a child in foster care should be offered HIV testing, or if the child lacks capacity to consent, he/she should be tested for HIV infection.

Adolescents and older children in foster care with the capacity to consent for HIV testing have the right to either consent for their own test or refuse testing.

For the commplete article, please refer to http://www.guidelines.gov/summary/summary.aspx?doc_id=6834

Health Horizons, an East Texas health care organization, has seen more HIV-positive people this year than it did all last year. As of July, eight people out of 800 had tested positive; whereas for all of 2008 they had only six positives out of more than 1,000 testers. The majority of these HIV-positive people were African-American men. Health Horizon’s Executive Director, Wilbert Brown, is associating the spike in numbers to their effective advertising which targets high-risk groups.

For the complete article, please visit http://hivtestingblog.com/original-articles/

Merck announced on Thursday that the FDA has approved expanded use of its HIV drug, Isentress, Reuters. Isentress has been FDA-approved since 2007, but was limited “to use in patients who had drug-resistant strains or were failing on other therapies, also in combination with other HIV drugs. Now it can be used in all adult patients,” the AP/CNBC.com reports. According to AP/CNBC.com, “Isentress is an integrase inhibitor, meaning it works by blocking the enzyme integrase, one of three types of enzymes the AIDS virus uses to reproduce and infect cells”

For the full article, please refer to http://www.medicalnewstoday.com/articles/157219.php

Emergency room patients who are most at risk for HIV are opting out of HIV testing at a huge rate amid a hospital atmosphere cold to such testing. Hospital personnel view it as too time-consuming, and insurers are reluctant to reimburse hospitals for their test-related expenses. In 2006, the Centers for Disease Control and Prevention recommended that everyone visiting a hospital for a major disease condition be tested for the virus that causes AIDS, with the opportunity for them to opt out of the testing, if they so chose.

Since then, only about 5 percent of such patients have been tested, according to Veronica Miller, director of the Forum for Collaborative HIV Research, an independent public-private partnership operating at the George Washington University School of Public Health and Health Services.

“HIV is a life-threatening disease that is so grossly underdiagnosed and undertreated in this country,” Miller said in a briefing on the two-day Summit on HIV Testing. It’s been found that infection rates in urban emergency rooms are from 0.5 percent to 1 percent of those tested – though many refuse testing, which involves a simple saliva test followed, if necessary, by a confirmatory blood test, all of which cost $80 to $120.

In Washington, D.C., where it’s estimated that 5 percent of people are infected with HIV, the George Washington University Medical Center emergency department found that only 0.8 percent of people tested were HIV positive. But half of those in the city’s wealthiest ward chose not to be tested, as did a third of people in the poorest ward. So it’s probably the case that the HIV rate is sharply higher among those who refuse the test.

A study done at Hahnemann University Hospital in Philadelphia found that patients’ acceptance of testing was boosted to 83 percent when trained counselors spent just five minutes pitching each emergency room patient. Such an increase could greatly benefit those who are HIV positive by catching the infection at an early stage, when it’s more treatable.

International migrant workers, foreign students and political refugees are often endangered by laws that discriminate against people with AIDS, the advocacy group Human Rights Watch reported last week.
The report describes how guest workers from poor countries like the Philippines and Sri Lanka working in wealthy ones like Saudi Arabia may be given mandatory H.I.V. testing — sometimes without their knowledge — and deported, often without being able to claim back wages and sometimes after imprisonment without treatment.
For the complete article, please see http://www.nytimes.com/2009/06/23/health/23glob.html?_r=1.