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HIV Test after 36 days : which test to do

HIV Test after 36 days : which test to do

Learn which test has the best chance of diagnosing an HIV infection , 36 days after exposure. In depth analysis of 3rd generation, 4th generation and RNA PCR tests as well as their likelihoods of showing positive.
Updated Date : 2023-09-11T20:54:05.696+00:00

How does the HIV virus multiply inside the body

When the HIV virus comes into contact with individuals, its replication commences within submucosal cells. Upon interacting with CD4 helper T cells, vital components of the immune system, the virus establishes a connection. Following this interaction, viral RNA, carrying the virus's genetic material, penetrates these CD4 cells. Subsequently, the viral RNA is transcribed into viral DNA via the action of reverse transcriptase. This introduced viral DNA takes control of the cell's machinery, steering it to produce an elevated number of viral particles. Eventually, the infected cell reaches its maximum capacity, leading to its rupture and the discharge of newly formed virions into the bloodstream.

What viral particles are in the body around 36 days after exposure?

At 36 a large percentage of patients will show the presence of the viral RNA using molecular assays, IgM antibodies will also be detectable in a good percentage of patients. Most patients should show detectable levels of IgG antibodies as well. The p24 antigen may no longer be detectable at this stage

The HIV Virus comprises of four detectable markers : HIV RNA, HIV P24 antigen, HIV IGM Antibodies and HIV IGG ANTIBODIES

Marker Description Day at First Detectable Day at Peak
HIV RNA A sign that the virus is active and multiplying in your body. Around 12 days Between 20 and 30 days
p24 Protein A protein produced by the virus, showing that its growing. About 15 days Between 25 and 30 days
IgM Antibodies Early soldiers your body sends to fight the virus. Around 20 days Between 30 and 35 days
IgG Antibodies Experienced soldiers your body creates for long-term defense. Between 30 and 35 days Not applicable

What is a window period?

The window period represents the delay between acquiring HIV and the ability of testing methods to identify the virus in bodily fluids.

Which are the different tests that can be done to detect HIV?

HIV can be identified through a range of tests, each directed at different elements of the virus. These encompass tests concentrating on the p24 antigen, distinct antibodies (IgM and IgG), and the employment of RNA PCR for heightened sensitivity.

Third Generation Tests

3rd generation tests are so called because they detect antibodies to the HIV 1 and HIV 2 strains. These tests are available in two formats - lab based automated assays, which automate the processes of pipetting and dispensing and point of care assays that can be done using standard manual pipetting.

Test Type Description Test Names
3rd Generation 3rd generation tests detect antibodies against HIV.
  • ADVIA Centaur HIV 1/O/2 Enhanced (Siemens): A lab-based automated test that detects antibodies to HIV-1 and HIV-2.
  • GS HIV-1/2 PLUS O EIA (Bio-Rad): This lab-based test identifies antibodies against HIV-1 and HIV-2.
  • VITROS Anti-HIV 1+2 (Ortho): An automated test for detecting antibodies to both HIV-1 and HIV-2.
  • INSTI HIV-1/HIV-2 Rapid (BioLytical, Point of Care): A point-of-care test that rapidly detects antibodies to HIV-1 and HIV-2.
Fourth Generation Tests

4th generation tests are so called because they detect both the HIV P24 antigen as well as antibodies to the HIV 1 and HIV 2 strains. These tests are available in two formats - lab based automated assays, which automate the processes of pipetting and dispensing and point of care assays that can be done using standard manual pipetting.

Test Type Description Test Names
4th Generation 4th generation tests detect both antigen and antibodies.
  • ADVIA Centaur HIV Ag/Ab Combo: A lab-based automated test that combines antigen and antibody detection for accurate HIV diagnosis.
  • ARCHITECT HIV Ag/Ab Combo (Abbott): Another lab-based automated test known for its reliability in detecting HIV antigen and antibodies.
  • BioPlex 2200 HIV Ag-Ab (Bio-Rad): This lab-based test utilizes a multiplex technology to simultaneously identify HIV antigen and antibodies.
  • Alere Determine (Point of Care): A point-of-care test that provides quick results, detecting both HIV antigen and antibodies.
Will a 4th generation lab based test detect HIV at 36 days?

Will a 4th generation lab based test detect HIV at 36 days?

There is a good chance of a 4th generation lab based test being able to detect the virus in your body on day 36 after exposure to the HIV virus.

A 4th generation HIV test is an advanced diagnostic tool that combines the detection of the HIV p24 antigen and antibodies (IgM and IgG) in a single test..Lab based assays as described above are fully automated and are considered to be one of the most sensitive tests for early diagnosis of HIV. If you were exposed to HIV, there is a 83.6% chance that the 4th generation lab based assay will be able to detect the virus at 36 days. This is based on the varying levels of the p24 antigen as well as the time it takes for the antibodies to develop in the body agains the virus. It is recommended that you retest after some days since the chances of detecting HIV increase with time.

Will a 4th generation Point of Care based test detect HIV at 36 days?

Will a 4th generation Point of Care based test detect HIV at 36 days?

There is a good chance of a 4th generation point of care based test being able to detect the virus in your body on day 36 after exposure to the HIV virus.

.Point of care assays as described above are generally performed with methods like lateral flow immunochromatography and are well suited for low resource and bedside settings. These assays have now achieved comparable results to lab based assays. If you were exposed to HIV, there is a 81.1% chance that a 4th generation point of care based assay will be able to detect the virus at 36. This is based on the varying levels of the p24 antigen as well as the time it takes for the antibodies to develop in the body agains the virus. It is recommended that you retest after some days since the chances of detecting HIV increase with time.

Will a third generation lab based assay detect HIV at 36 days?

Will a third generation lab based assay detect HIV at 36 days?

There is a good chance of a 3rd generation lab based test being able to detect the virus in your body on day 36 after exposure to the HIV virus.

The 3rd generation HIV test is an established diagnostic technique that simultaneously detects IgM and IgG antibodies against the virus, aiding in timely diagnosis..Third generation assay only test for the IgM and IgG antibodies, as such the latency for positivity with these assays is greater. Third generation lab based assays use automation in various steps of the test and as such are considered to be more accurate than the point of care tests, however they require more expensive equipment. If you were exposed to HIV, there is a 75.0% chance that a 3rd generation lab based assay will be able to detect the virus at 36 days. This is based on the time it takes for the antibodies to develop in the body agains the virus. It is recommended that you retest after some days since the chances of detecting HIV increase with time.

Will a third generation point of care based assay detect HIV at 36 days?

Will a third generation point of care based assay detect HIV at 36 days?

There is a relatively high chance of a 3rd generation point of care based test being able to detect the virus in your body on day 36 after exposure to the HIV virus.

.Third generation assay only test for the IgM and IgG antibodies, as such the latency for positivity with these assays is greater. Third generation point of care based assays use lateral flow chromatography or similar techniques and are suited for low resource settings. If you were exposed to HIV, there is a 59.9% chance, that a 3rd generation point of care based assay will be able to detect the virus at 36 days. This is based on the time it takes for the antibodies to develop in the body agains the virus. It is recommended that you retest after some days since the chances of detecting HIV increase with time.

Will a RNA PCR test detect HIV at 36 days?

Will a RNA PCR test detect HIV at 36 days?

There is a good chance of a RNA PCR Molecular Test being able to detect the virus in your body on day 36 after exposure to the HIV virus.

RNA PCR assays can detect viral loads as low as 20 copies of viral RNA/ml. RNA PCR assays can detect the virus as early as 10-12 days, and almost all patients will show positivity between 20-30 days.Based on the fact that you have been exposed 36 days ago, there is a 99.0% chance of the RNA PCR test being able to detect the virus.

What is the confirmatory test for HIV at 36?

There is no 100% confirmatory test for HIV. Any negative test is recommended to be repeated after 45-90 days. Positive tests are usually reconfirmed on repeated sampling in accordance with the guidelines of your country's health organizations. While the RNA PCR test usually has the highest chance of detecting the virus, it is never recommended as a first line test, owing to its cost and complexity. A first line screening test is usually done (4th generation) and if it is positive, additional testing is recommeded.

References

  • Hurt CB, Nelson JAE, Hightow-Weidman LB, Miller WC. Selecting an HIV Test: A Narrative Review for Clinicians and Researchers. Sex Transm Dis. 2017 Dec;44(12):739-746. doi: 10.1097/OLQ.0000000000000719. PMID: 29140890; PMCID: PMC5718364.Hurt et,al
  • Kevin P. Delaney and others, Time Until Emergence of HIV Test Reactivity Following Infection With HIV-1: Implications for Interpreting Test Results and Retesting After Exposure, Clinical Infectious Diseases, Volume 64, Issue 1, 1 January 2017, Pages 53–59,Delaney et.al

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Dr.Bhargav Raut is a qualified Pathologist, with over 5 years of experience in the field
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