Doctor Today

HIV test (includes mandatory sexual health test consultation)

What is HIV?

HIV is a viral infection that is transmitted by intimate sexual contact, infected blood, sharing needles or stick injury, pregnancy and birth.

The clinical signs of HIV infection may not appear until the disease is well advanced, but flu-like symptoms may occur at any time from 1 to 3 months after infection starts; these include enlarged lymph nodes, fever, headache, muscle pains and tiredness. The AIDS syndrome which occurs in up to 50% of carriers may not appear until many years later when the destruction of the immune response leads to progressive inability to fight infections, wasting and certain cancers. Usually an HIV carrier will remain infective in spite of not having the overt signs of AIDS - you cannot tell if someone is an HIV carrier just by looking at them.

Prevention is the best strategy (safe sex, avoid sharing needles) since there is at present no effective vaccine. For those infected with HIV, cure is problematic. Modern therapy can do much to improve quality of life and to reduce viral load and infectivity, however, so the sooner the treatment is started the better.

HIV Testing at Doctor Today

The test used at Doctor Today to diagnose HIV infection is called the HIV-DUO. This costs £100 inclusive of a sexual health consultation and tests for both HIV 1&2 antibodies (formed in reaction to the virus) and the p24 antigen (part of the virus itself) for earlier diagnosis. Results for this test are usually available within one working day (usually on the same day for those with weekday appointments before 2pm, and by 11am the next business day morning for those with appointments between 2pm and 8pm). This test will usually become positive from 4 weeks after the contact which causes infection. For confirmation purposes, a second test at 3 to 6 months is advised if the initial test is negative. If both are negative, you can be very sure (99.99%) you are not infected with the HIV virus (this is of course provided no further contacts occur in the meantime; you are advised to maintain a policy of safe sex during this period). If earlier diagnosis is required, the HIV-1 proviral DNA by PCR test can be done from day 10 to 14 post-contact, but is more expensive; in addition, not only do results take longer (several days), but the test is also not quite as general as the DUO as it applies only to HIV-1 infections (the normal type). HIV-2 infection is more common in West African countries and if your contact may have been in this area, you should back up the HIV-1 proviral DNA test with a DUO test at 4 weeks.

If your initial test is positive, we perform further confirmatory tests for you free of charge. This consists of three divergent methodologies to cross-check the positive result, as clearly a firm and accurate diagnosis is of the utmost importance. If a positive result is confirmed, we are able to advise you appropriately and to refer you to a specialist clinic for further management.

Why we do not use "instant" HIV Tests

The directors of Doctor Today have taken the view that so-called "instant" HIV testing by the INSTI or other point of care method will not be offered at this time to our patients for the following reasons:

In areas of low HIV prevalence such as UK, 6 out of every 7 positive instant tests are in fact likely to turn out to be negative, so patients may be given unnecessary anxiety for no good reason.

• There is also a small but appreciable false negative rate with instant tests (i.e. test shows negative but in fact the patient is positive), which could be disastrous for the patient and their partners if the instant test is relied upon.
  
• An instant test is not a lot cheaper (at our clinic) than the HIV-DUO test. Any positive test would have to be followed up with by confirmatory testing which is more sensitive, so the cost of this would have to be extra. In our clinic the confirmatory testing after a positive HIV-DUO test is done free of charge to the patient. This can be very expensive if it is done separately and is something you need to take into account when choosing where to have your test done.
  
• The instant test turns positive some time after the HIV-DUO test is positive (i.e. there is a longer "window period").
  
• There is no p24 antigen testing with the instant tests which is a big advantage of the HIV-DUO test, the results for which are usually back within one working day.