HIV Status Interpretation: Positive Rapid Test with Negative Confirmatory Antibody Test

Diagnostic Algorithm

A patient with a positive rapid HIV test but negative HIV antibody confirmation test should not be diagnosed with HIV infection and should be considered uninfected in the absence of epidemiologic risk factors, as recommended by the Centers for Disease Control and Prevention 1, 2, 3, 4, 5, 6
If the HIV-1 Western blot is negative and HIV-2 EIA is not repeatedly reactive, the specimen should be considered negative for HIV antibodies, according to the Centers for Disease Control and Prevention 1, 2, 3, 4
The patient should be informed that test results for HIV infection are negative, as stated by the Centers for Disease Control and Prevention 1, 2, 3
In the absence of recognized epidemiologic risk factors, the patient should be considered uninfected with HIV and counseled accordingly, as recommended by the Centers for Disease Control and Prevention 2, 4, 5

For women in labor with a positive rapid HIV test, antiretroviral prophylaxis should be administered to mother and newborn based on the positive rapid test without waiting for confirmatory results, as recommended by the American Academy of Pediatrics 9
If confirmatory test results are negative, prophylaxis should be stopped and breastfeeding may be initiated, according to the American Academy of Pediatrics 9

Treatment for HIV should never be initiated until infection has been documented with confirmatory testing, as recommended by the Centers for Disease Control and Prevention 7, 8
All positive screening tests must be confirmed by Western blot or indirect immunofluorescence assay before establishing a definitive HIV diagnosis, according to the Centers for Disease Control and Prevention 7

Send confirmatory testing immediately (Western blot or indirect immunofluorescence assay), as recommended by the Centers for Disease Control and Prevention 7, 8
If negative confirmation, consider patient uninfected unless high-risk exposure within past 4-6 weeks, as stated by the Centers for Disease Control and Prevention 1, 2, 3, 4
If acute infection suspected, order HIV RNA assay to exclude window period infection, as recommended by the Centers for Disease Control and Prevention 8
If indeterminate confirmation, perform HIV-2 EIA testing and follow-up testing at 4 weeks, then 6 months if still indeterminate, according to the Centers for Disease Control and Prevention 3, 4, 8
Counsel on risk reduction during the follow-up period regardless of initial interpretation, as recommended by the Centers for Disease Control and Prevention 3, 4