HIV Test after 25 days : which test to do

Published Date : 2023-09-10T20:54:05.696Z

Updated Date : 2023-09-10T20:54:05.696+00:00

How does the HIV virus multiply inside the body

As individuals encounter the HIV virus, its replication commences within submucosal cells. CD4 helper T cells, vital components of the immune response, become engaged as the virus establishes contact. Following this interaction, viral RNA, carrying the virus's genetic code, infiltrates the CD4 cells. The viral RNA undergoes conversion into viral DNA through the activity of reverse transcriptase. This introduced viral DNA assumes control of the cell's processes, leading to the production of a greater number of viral particles. Ultimately, the infected cell reaches its limit, leading to its rupture and the liberation of newly generated virions into the bloodstream.

What viral particles are in the body around 25 days after exposure?

At 25 a large percentage of patients will show the presence of the viral RNA using molecular assays, as well as the p24 antigen by means of lab assays, IgM antibodies will also be detectable in a good percentage of patients. A very few patients may show early detectable levels of the IgG antibodies.

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

What is a window period?

A window period is the early stage of HIV infection when viral replication is vigorous but test sensitivity is limited by the scarcity of detectable viral antigens.

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

Various testing methods are available for HIV detection, combining different approaches to target components like the p24 antigen, specific antibodies (IgM and IgG), and the use 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.

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.

Will a 4th generation lab based test detect HIV at 25 days?

There is a relatively high chance of a 4th generation lab based test being able to detect the virus in your body on day 25 after exposure to the HIV virus.

A 4th generation HIV test is a state-of-the-art screening tool capable of detecting both the p24 antigen and IgM/IgG antibodies concurrently, improving accuracy..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 58.1% chance that the 4th generation lab based assay will be able to detect the virus at 25 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 25 days?

There is a relatively high chance of a 4th generation point of care based test being able to detect the virus in your body on day 25 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 56.3% chance that a 4th generation point of care based assay will be able to detect the virus at 25. 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 25 days?

There is a relatively high chance of a 3rd generation lab based test being able to detect the virus in your body on day 25 after exposure to the HIV virus.

An established diagnostic approach, the 3rd generation HIV test detects both IgM and IgG antibodies against the virus, aiding in its timely identification..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 52.1% chance that a 3rd generation lab based assay will be able to detect the virus at 25 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 25 days?

There is a moderate chance of a 3rd generation point of care based test being able to detect the virus in your body on day 25 after exposure to the HIV virus. This is because the analytes measured by this test, namely - IgM and IgG antibodies are not yet present in adequate concentration in your blood by day 25 of the infection.

.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 41.6% chance, that a 3rd generation point of care based assay will be able to detect the virus at 25 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 25 days?

There is a good chance of a RNA PCR Molecular Test being able to detect the virus in your body on day 25 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 25 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 25?

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