HIV Diagnosis and Disclosure Guidelines

Introduction to HIV Testing and Diagnosis

The Centers for Disease Control and Prevention recommends that all positive screening tests must be confirmed by Western blot or indirect immunofluorescence assay before establishing a definitive HIV diagnosis 1
The American College of Physicians explicitly states that treatment for HIV should never be initiated until infection has been documented with confirmatory testing 2

The American College of Physicians recommends explaining that the screening test is reactive but requires confirmatory testing to establish the diagnosis 1, 2
The Centers for Disease Control and Prevention emphasizes the importance of providing appropriate counseling by someone able to discuss medical, psychological, and social implications 1

The American College of Obstetricians and Gynecologists recommends that pregnant women with preliminary positive results should receive antiretroviral prophylaxis during labor to prevent perinatal transmission while awaiting confirmation 2
The Centers for Disease Control and Prevention states that infants born to seropositive mothers require definitive diagnosis, which involves either antibody persistence beyond 15 months with compatible clinical course, or laboratory evidence of HIV by culture, nucleic acid, or antigen detection 1

The Centers for Disease Control and Prevention recommends sending confirmatory testing immediately, such as Western blot or indirect immunofluorescence assay 1, 2
The American College of Physicians suggests that if confirmatory testing is negative or indeterminate, follow-up testing on a blood specimen collected 4 weeks after the initial reactive test should be performed 2

The Centers for Disease Control and Prevention states that informed consent must be obtained before HIV testing, with some states requiring written consent 1
The American College of Physicians recommends that pretest and posttest counseling are essential components of the testing process 1