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Identifying Acute HIV Infections
For more than two decades HIV diagnostic testing primarily has
relied on the detection of HIV specific antibodies that are produced
as part of the host immune response to the infection.
However, using existing HIV screening tests, detectable levels
of HIV specific antibodies cannot be demonstrated in blood for
at least one to two weeks after HIV genetic material (RNA) can
be detected in the blood by nucleic acid amplification testing
(NAAT).2,10 Therefore HIV-1 NAAT has become the method of
choice to identify acute HIV-1 infections. The early stage of an
acute HIV infection is known as the "window phase.鈥?The window
phase is characterized by high levels of HIV in the blood
(viremia) that can be detected by HIV-1 NAAT prior to the production
of HIV specific antibodies (seroconversion) by the
acutely infected individual. The duration of the window phase is
determined by the relative sensitivity of HIV antibody screening
(Enzyme Immuno-Assay: EIA or rapid point-of-care tests).
Newer, third-generation EIA鈥檚 based on recombinant or synthetic
peptide antigens generally can detect HIV specific antibodies
days or weeks earlier than EIA鈥檚 based on whole viral
lysate antigens that were originally developed in the 1980鈥檚 or
early 1990鈥檚.9 Additionally, newer, third-generation EIA鈥檚 are
more sensitive than the traditional HIV-1 western blot confirmatory
assay and most of the rapid point-of-care screening tests.
Many third-generation EIA reactive specimens from acutely
HIV-1 infected individuals can be initially non-reactive in rapid
screening tests or, if reactive in newer generation screening
immunoassays, cannot be confirmed as HIV-1 antibody-positive
by less sensitive traditional western blot (WB) testing. This
effectively prolongs the time of the window phase until HIV-1
seroconversion can be confirmed.
HIV-1

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