Testing during primary infection

Detecting acute infection

Viral loads tests (HIV RNA) may be used to detect the presence of HIV in the body prior to the development of antibodies. The standard means of identifying HIV-positive people is through the use of antibody tests. The appearance of antibodies in the blood is often accompanied by a seroconversion illness. Seroconversion is often preceded by a burst in viral replication, and high viral load is common among people recently exposed to HIV.

If HIV infection is suspected (for example, someone knows or suspects they were exposed through sexual contact or needle-sharing), an HIV p24 antigen test can detect HIV infection seven days prior to the appearance of HIV antibodies. Viral load testing is even more sensitive than p24 antigen testing; HIV RNA can be detected in the blood two or three days prior to p24 antigen. The benefit of HIV RNA testing during suspected acute infection is to reduce the period of diagnostic uncertainty and facilitate very early treatment.

A person who tests positive for HIV in the blood, despite negative or indeterminate antibody results, is said to have primary HIV infection. However, false positive results are fairly common. A viral load result of less than 5000 copies/ml during primary infection is probably suggestive of a false positive result, because most people have viral loads above 100,000 during this time.

There is disagreement among experts about the appropriate use of viral load testing during the early days of HIV infection. Some doctors recommend testing for people with symptoms of seroconversion illness who may have been exposed to HIV. Others are less enthusiastic about the uses of viral testing for asymptomatic individuals with a possible exposure to HIV because of a low yield in actual cases of HIV infection and the risk of false positive results.

Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.