What is the role of lab assays in the diagnosis and monitoring of HIV infection?

Updated: Jun 23, 2020
  • Author: Philip A Chan, MD, MS; Chief Editor: John Bartlett, MD  more...
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HIV infection is diagnosed with a combination of screening and confirmatory tests. Newer HIV diagnostic tests involve combined antibody and antigen assays, leading to earlier detection of HIV infection. Diagnosing acute HIV infection (ie, before the formation of HIV antibodies, a period when antibody-based HIV test results may be falsely negative) remains a challenge.

During therapy, it is crucial to monitor the response, both in terms of immune reconstitution and viral replication. Treatment failure may result from development of drug resistance mutations in the virus. Some mutations result in resistance to multiple antiretroviral agents or to entire drug classes. Special tests include antiretroviral resistance testing by genotype or phenotype, genetic testing for HLA-B*5701 (associated with abacavir hypersensitivity), and viral tropism testing (ie, CCR5) for maraviroc.

In addition, laboratory testing for other sexually transmitted diseases (STDs; syphilis, gonorrhea, and chlamydia infection) is warranted for people living with HIV infection and people who are HIV-negative but at risk for infection.

The HIV/AIDS epidemic continues to affect people across the world. [1] Recent advances in the treatment and prevention of HIV infection have provided the necessary tools to end the HIV epidemic. Early diagnosis and treatment of HIV infection with subsequent viral suppression is a cornerstone of HIV prevention efforts. Treatment of HIV infection with antiretroviral agents and viral suppression prevents transmission of the virus to others. [2, 3] In addition, pre-exposure prophylaxis (PrEP) via daily administration of an antiretroviral agent prevents HIV infection. [4] Together, these approaches have the potential to significantly address the HIV epidemic.

The challenges of effectively addressing the HIV epidemic include access to HIV testing and early diagnosis, a prolonged asymptomatic period of infection during which the virus can be transmitted to others, and achievement of viral suppression via timely antiretroviral therapy. All of these rely on laboratory testing to some extent. Several laboratory methods are used to diagnose and manage HIV infection, and medical providers should be aware of the availability, utility, and limitations of these methods.

For other discussions on management of HIV infection, see HIV Infection and AIDS, Pediatric HIV Infection, and Antiretroviral Therapy for HIV Infection.

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