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Disease Categories > Infectious Disease > Viruses

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Human Immunodeficiency Virus - HIV

Human immunodeficiency virus 1 (HIV-1) is thought to have originated as a zoonotic transmission from SIV-infected primates, while human immunodeficiency virus (HIV-2) is thought to have originated as a zoonotic transmission from Sooty Mangabeys.

HIV-1 and HIV-2 are etiologic agents of acquired immunodeficiency syndrome (AIDS)
HIV-1 accounts for the vast majority of all HIV infections in the U.S.
- Includes group M and at least 10 subtypes (A through J)
  - Group O (for outlier)
  - Group N (for non-M, non-O)
HIV-2 is endemic to West Africa and rarely seen in U.S.
- Includes groups A through E

Transmission

Primarily via sexual contact
Parenterally and perinatally
Tissue transplantation
Can be prevented in 98% of infants of infected mothers by drug therapy during pregnancy, elective caesarian section and refraining from breastfeeding
Blood-borne; not transmitted via saliva, insect vectors or household contacts

Clinical Presentation

Acute symptoms include fever, fatigue, rash, headache, lymphadenopathy, pharyngitis, myalgias, nausea, vomiting, diarrhea and night sweats

Diagnosis

Early diagnosis is crucial to institute highly active antiretroviral therapy (HAART)
- Reduces risk of devastating complications of full-blown AIDS
- Prevents further spread of HIV
Viral spread from local inoculation occurs quickly
- 30 billion virus particles produced in first weeks of infection
Antibodies detected approximately 22 to 27 days after acute infection
Rapid screening tests are newly available (HIV ½ Stat-Pak, Multispot, Oraquick, Reveal, Sure Check HIV, Unigold)
- Overall sensitivity and specificity >99%
Quantitative and drug resistance testing allows for monitoring during treatment

Click here for table of Comparisons of STI Screening Recommendations for Sexually Active Nonpregnant Women

Click here for table of Comparisons of STI Screening Recommendations for Pregnant Women

Indications for Ordering

Tests generally appear in the order most useful for common clinical situations
Click on number for test-specific information in the ARUP Laboratory Test Directory

Test Name and Number	Recommended Use	Limitations	Follow Up
Human Immunodeficiency Virus 1 Antibody, Confirmation 0020284 Method: Western Blot	If screening test is repeatedly reactive, the laboratory automatically performs Western Blot	Do not use for blood donor screening, associated re-entry protocols or for screening human cell and cellular and tissue-based products (HCT/P)
Human Immunodeficiency Virus 1 Antibody with Reflex to Confirmation by Western Blot 0051154 Method: Enzyme Immunoassay/Western Blot	Screen for presence of HIV-1 infection
Human Immunodeficiency Virus 1,2 Combined Antibodies with Reflex to HIV-1 Confirmation by Western Blot 0051160 Method: Enzyme Immunoassay/Western Blot	Screen for presence of HIV infection Screen for antibodies against HIV-1 and HIV-2
Human Immunodeficiency Virus 2 Antibody Confirmation by Immunoblot 0093272 Method: Immunoblot	Confirm positive screening results
Human Immunodeficiency Virus 1 RNA Quantitative bDNA 0020466 Method: Branched Chain DNA	Use with clinical presentation as indicator of disease prognosis Use as aid in assessing viral response to antiretroviral treatment	A result less than 75 HIV copies/ML does not rule out the presence of inhibitors in the patient specimen or HIV-1 virus RNA concentrations below the limit of detection by the assay
Human Immunodeficiency Virus 1 DNA PCR, Qualitative 0093061 Method: Polymerase Chain Reaction	Detects HIV-1 proviral DNA in infants (before 48 hours, 1-2 months and 3-6 months of age)	Do not use umbilical cord blood due to contamination with mother’s blood
Human Immunodeficiency Virus 1 RNA Quantitative PCR 0055598 Method: Polymerase Chain Reaction	Use in conjunction with clinical presentation as indicator of disease prognosis Use as aid in assessing viral response to antiretroviral treatment	False-positive results may occur; care should be taken when interpreting, especially for seronegative patients A result less than 400 HIV copies/ML does not rule out the presence of inhibitors in the patient specimen or HIV-1 virus RNA concentrations below the limit of detection by the assay
Human Immunodeficiency Virus 2 Antibody with Reflex to Confirmation 0051250 Method: Enzyme Immunoassay/Immunoblot	Screen for presence of HIV-2 infection in patient with epidemiologic link to Africa		Repeatedly reactive EIA results will be confirmed by immunoblot testing
Lymphocyte Subset Panel 1 - CD4 Absolute Count Only 0095854 Method: Flow Cytometry	Monitor treatment efficacy Determine T-cell (CD4) levels to establish decision points for initiating P. jiroveci prophylaxis, antiviral therapy Order concurrently with HIV viral load monitoring tests		The Public Health Service (PHS) has recommended that Helper T-cell levels be monitored every 3 to 6 months in all HIV-infected persons Other lymphocyte panels are available See list of additional tests available
Human Immunodeficiency Virus 1, Genotyping 0055670 Method: Reverse Transcription Polymerase Chain Reaction/DNA Sequencing	Detect changes in the viral genome that are associated with drug resistance Use in conjunction with CD4 measurement to monitor treatment efficacy Test requires specimens with HIV-1 RNA plasma levels of greater than 1,000 copies/mL	Treatment failure can be caused by factors other than drug resistance; therefore, the interpretation of resistance genotyping results must be done in conjunction with other clinical and laboratory information Comparisons between assays performed in different laboratories are not recommended since no method standardization exists among HIV-1 drug resistance testing Results from different test methods/algorithms may provide different resistance interpretation The absence of resistance mutations does not rule out the presence of reservoirs of resistant viruses that cannot be detected by these tests Some specimens with HIV-1 RNA plasma levels greater than 1,000 copies/mL may not provide adequate data due to polymorphisms in the priming areas of the genome

Additional Tests Available

Click on number for test-specific information in the ARUP Laboratory Test Directory

Test Name and Number	Comments
Human Immunodeficiency Virus 1 RNA Quantitative PCR with Reflex to Human Immunodeficiency Virus 1 Genotyping 0051660 Method: Polymerase Chain Reaction/Genotyping	Panel test Use with clinical presentation as an indicator of disease prognosis and assess viral response to antiretroviral treatment
Human Immunodeficiency Virus 1 RNA Quantitative bDNA with Reflex to Human Immunodeficiency Virus 1 Genotyping 0051664 Method: Branched Chain DNA/Genotyping	Panel test Use with clinical presentation as an indicator of disease prognosis and assess viral response to antiretroviral treatment
Lymphocyte Subset Panel 2 - CD4 Percent & Absolute 0095885 Method: Flow Cytometry
Lymphocyte Subset Panel 3 - T-Cell Subsets (CD4 & CD8), Absolute Counts Only 0095853 Method: Flow Cytometry
Lymphocyte Subset Panel 4 - T-Cell Subsets Percent & Absolute, Whole Blood 0095950 Method: Flow Cytometry
Lymphocyte Subset Panel 5 - Total Lymphocyte Enumeration 0095892 Method: Flow Cytometry
Lymphocyte Subset Panel 6 - Total Lymphocyte Enumeration with CD45RA & CD45RO 0095862 Method: Flow Cytometry
Erythropoietin 0050227 Method: Chemiluminescent Immunoassay

Additional Information

For HIV-1 anti-retroviral drugs genotyping analysis, refer to Human Immunodeficiency Virus 1, Antiretroviral Drug Resistance Testing - HIV Drug Resistance topic.

Guidelines

Adolescents and human immunodeficiency virus infection: the role of the pediatrician in prevention and intervention. American Academy of Pediatrics - Medical Specialty Society. 2001 Jan. 3 pages. NGC:002002 (Link to NGC)

Hammer SM, Saag MS, Schechter M, Montaner JS, Schooley RT, Jacobsen DM, Thompson MA, Carpenter CC, Fischl MA, Gazzard BG, Gatell JM, Hirsch MS, Katzenstein DA, Richman DD, Vella S, Yeni PG, Volberding PA. Treatment for adult HIV infection: 2006 recommendations of the International AIDS Society-USA panel. JAMA. 2006;296(7):827-843. (Link to PubMed)

Primary care guidelines for the management of persons infected with human immunodeficiency virus: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Infectious Diseases Society of America - Medical Specialty Society. 2004 Sep 1. 21 pages. NGC:003793 (Link to NGC)

Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. Centers for Disease Control and Prevention - Federal Government Agency [U.S.]. 2001 Nov 9 (revised 2006 Sep 22). 17 pages. NGC:005246 (Link to NGC)

Cited References

Meyers, D., Wolff, T., Gregory, K., et al. USPSTF Recommendations for STI Screening. Originally published in Am Fam Physician 2008;77:819-824. Agency for Healthcare Research and Quality, Rockville, MD. (Accessed on July 15, 2008) (Link to resource)

General References

Johnson VA, Brun-Vezinet F, Clotet B, Kuritzkes DR, Pillay D, Schapiro JM, Richman DD. Update of the Drug Resistance Mutations in HIV-1: Fall 2006. Top HIV Med. 2006;14(3):125-130. (Link to PubMed)

Pilcher CD, Eron JJ Jr, Galvin S, Gay C, Cohen MS. Acute HIV revisited: new opportunities for treatment and prevention. J Clin Invest. 2004;113(7):937-945. (Link to PubMed)

Richman DD. Benefits and limitations of testing for resistance to HIV drugs . J Antimicrob Chemother. 2004;53(4):555-557. (Link to PubMed)

References from the ARUP Institute for Clinical and Experimental Pathology®

Choi HH, Gray PB, Storer TW, Calof OM, Woodhouse L, Singh AB, Padero C, Mac RP, Sinha-Hikim I, Shen R, Dzekov J, Dzekov C, Kushnir MM, Rockwood AL, Meikle AW, Lee ML, Hays RD, Bhasin S. Effects of testosterone replacement in human immunodeficiency virus-infected women with weight loss. J Clin Endocrinol Metab. 2005;90(3):1531-1541. (Link to PubMed)

Salama ME, Perkins SL, Mariappan MR. Images in HIV/AIDS. Primary bone marrow presentation of Epstein-Barr virus-driven HIV-associated Hodgkin lymphoma. AIDS Read. 2007;17(12):604-605. (Link to PubMed)

Reviewed by

Hillyard, David R., M.D. Medical Director, Molecular Infectious Diseases at ARUP Laboratories; Associate Professor, Pathology, University of Utah

Litwin, Christine, M.D. Medical Director, Immunology at ARUP Laboratories; Professor, Clinical Pathology, University of Utah

Reimer, Larry G., M.D. Medical Director, Microbiology, Veteran's Affair Hospital; Professor of Pathology and Associate Dean for Curriculum and GME, University of Utah School of Medicine

Comprehensive Review: November 2007
Last Update: July 2008