London, England – Throughout April, the Royal London Hospital, in Whitechapel, UK is offering everyone having a blood test taken in accident and emergency (A&E) departments a routine HIV screening.
Human immunodeficiency virus (HIV) is a lentivirus (slowly replicating retrovirus) that is a precursor to acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune system allows life-threatening opportunistic infections to thrive.
Infection with HIV occurs through the transfer of blood, semen, and other bodily fluids. Within these fluids, HIV is present as both free virus particles and virus within infected cells.
Typically a patient or physician must specifically request an HIV test, and only when it is deemed necessary – those seen as high risk like intravenous drug users. HIV testing is initially by an enzyme-linked immunosorbent assay (ELISA) to detect antibodies to HIV. A western blot is often employed for additional confirmation.
Specimens with a nonreactive result from the initial ELISA are considered HIV-negative unless new exposure to an infected partner or partner of unknown HIV status has occurred.
Modern HIV testing is extremely accurate. Screening has a 99 percent accuracy rate. Testing post exposure is recommended initially and at six weeks, three months, and six months.
The pilot offer for testing has been seen as a necessary attempt to diagnose the undiagnosed, as the average 25 percent of those unaware they are infected with human immunodeficiency virus have a causational link to 75 percent of newly acquired HIV cases.
Between 1990 and 2010, cases of HIV infection rose in the UK by 76 percent due to fewer people using condoms. According to Dr. Ann Sullivan, from the Sexual Health Centre at Chelsea and Westminster Hospital, straight men are the least likely to be regularly tested.
The condition is symptomless for a prolonged period from onset, thus by the time a person realizes they’re positive for the virus, they’ve likely but unknowingly infected others prior to diagnosis.
The campaign – which was organized by Barts Health NHS Trust and the HIV charity Saving Lives – is being piloted in Whitechapel because the area is thought to have an HIV population five times the size of the national average. In Whitechapel, six in every 1,000 people are believed to be HIV positive.
The program stirs the old debate, should all patients be automatically screened for HIV/AIDs when receiving medical treatment in the ER or hospital, including here in the US? Several medical institutions say yes, as patients with HIV have far better odds of longevity if they begin treatment for the disease as soon as possible. Additionally, awareness limits the exposure and infection to others as well as encouraging medical staff handling the patients to take proper precautions.
A similar pilot program was launched in four Vancouver hospitals, where patients were screened for HIV when admitted. More than 30 unaware people tested positive during the first year of the offered screening, which began in October 2011.
The provincial government in Vancouver recently announced it will be expanding the pilot project to the rest of the province next year as part of a plan called STOP HIV/AIDS.
In the US, the Centers for Disease Control and Prevention (CDC) recommend all people between the ages of 13 and 64 get tested for HIV regardless of risk. Drugstores sell what is referred to as a rapid oral swab test that can produce results in as little as 20 minutes. Along with oral fluids, the test can screen blood from a finger stick or plasma.
According to the CDC, 1.2 million Americans have HIV, but one-fifth of those are unaware. About 50,000 Americans per year become infected with HIV. Among those who get tested using traditional methods, 31 percent of those who test positive do not return for their results. Traditional HIV tests require an entire vial of blood and take up to two weeks to get results.
In 20 minutes, the oral test device indicates if HIV antibodies are present with 99.8 percent accuracy. If the result is positive, it has to be confirmed with an additional, more specific test called a western blot.
As with all antibody tests for HIV, it could take from two to 12 weeks for a newly infected person to develop antibodies to the HIV virus and thus test positive for HIV. Therefore, if there is a negative result and a possibility of a recent exposure to HIV, the test must be repeated in 12 weeks.
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