Page 284 - AIDSBK23C

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HIV TESTING AND COUNSELING

Testing for HIV infection in patients has become an important issue for health care
professionals in many disciplines and locations, not just for those in large metropolitan areas.
Patients must receive adequate HIV test counseling and education. The mainstay of initial HIV
testing in developed nations is the EIA test for HIV antibody, with all initial positives confirmed
by a second more specific test, usually a Western blot. False positive EIA tests or indeterminate
Western blot tests can occur but will constitute a smaller fraction of the total positives as the
prevalence of HIV infection increases in the population tested. In addition to initial testing, the
patient should be informed that additional testing may be warranted because HIV antibodies may
not appear for 6 to 12 weeks (and rarely longer) after primary infection or because indeterminate
results may appear. The patient should be provided with counseling and support as necessary to
deal with the stress involved in testing and waiting for results.[172,251,342,354]
Persons to be tested should be identified primarily on the basis of their history of risk
factors for HIV infection (Table 2). The history taking must include very frank, but non-
judgmental and open-ended questions, which are asked in order to elicit specific risks related to
sexual behavior and drug use. In the course of taking a history and performing a physical
examination, findings that suggest the presence of sexually transmitted diseases, opportunistic
infections or neoplasms characteristic of HIV infection, or physical findings of acute or advanced
HIV infection should suggest the need for HIV testing. Health care professionals who display
compassionate care and allow the patient to ask questions and express feelings through open
communication will provide the best setting in which testing can proceed in the best interests of
the patient as well as allow for educational efforts to be successful. Patient education should
include information about: how HIV is spread, what can be done to decrease the risk of HIV
infection, how HIV infection affects the body, what danger exists to others from an infected
person, what treatments are available, and what the course of the disease is to the final outcome--
death.[115,130,157,166,169,251]
Patients should be informed that some facilities may offer "anonymous" HIV testing in
which no specific identifying information about them is collected. Such anonymous testing will
provide the patient only with a positive or negative result outside of the context of continuing
medical care, and additional care will require informing a physician about such results. Patients
should be informed that "confidential" testing by most health care facilities requires specific
patient consent and that positive results will be reported to public health officials as required by
law. Health care professionals should obtain consent for such confidential testing according to
local statutes and should be aware of the minimum age at which persons can legally give
consent. Physicians should also be aware of the need to maintain confidentiality of additional
test results such as total lymphocyte or CD4 lymphocyte counts, microbiologic cultures, or tissue
diagnoses (e.g., Kaposi's sarcoma) which have strong implications concerning possible HIV
infection.[1116]
Persons who have been tested should be provided with the opportunity to obtain and
freely discuss the results with the physician.[1117,1118] Even if the result is negative, such a
session provides an opportunity to reinforce the educational information about HIV. A positive
result should be discussed in regard to understanding what this result means about life
expectancy, the need for eventual medical care and treatment, the need to inform others who
have been exposed to HIV, the need to modify behaviors to reduce the risk for spread to others,