Home HIV Testing

For many years now, we’ve been using the OraQuick® HIV Test in the Johns Hopkins Emergency Department to quickly test a person for HIV. So I was a little surprised the other day when I heard some of the staff discussing OraQuick as a new product that’s getting coverage in the news.

Then I realized that OraQuick’s recent newsworthiness has to do with its approval by the Food and Drug Administration as an over-the-counter product that people can use at home to test for the human immunodeficiency virus (HIV, the virus that causes AIDS).

A Laborious Testing Process

For years, we’ve first had to get patients’ consent to test them for HIV and then counsel them before and after we do the actual test. Only recently have we been allowed to test patients without repeatedly getting their consent before every test.

So this idea of testing at home for HIV is revolutionary, but it also comes with some important caveats—let’s discuss both the good and the cautionary news.

The Revolution

HIV is a virus that can have a long latent period between the initial infection and the beginning of serious symptoms. This lag between infection and symptoms is why many people are unaware of their HIV infection and why, unfortunately, they can unknowingly spread the virus to others.

Experts estimate that about one-fifth of individuals currently infected with HIV are unaware that they are HIV positive. Healthcare professionals are hoping that allowing people to test for HIV at home will mean that many who might otherwise not get tested will now find out their status in the privacy of their homes.

The idea is that home testing will raise awareness of the virus, will encourage people to get earlier treatment and medical care, and will ultimately decrease person-to-person transmission of the virus.

A Caution—False Positives

Alas, the test is not perfect. Even in the hospital, we only use OraQuick as a screening device. By “screening,” I mean that whenever we get a positive test result with OraQuick, we always get a second, confirmatory test with a completely different type of test. One of every 5,000 of these initial positive tests is a false-positive result—the person turns out not to have HIV at all.

Another Caution—False Negatives

Also, no HIV test is able to show a positive result during the early, latent phases of the HIV infection. This means that some people who initially test negative really are in fact infected with the virus, even though the test doesn’t detect the virus at that time. The test will be positive, however, at some point up to 6 months later. In clinical trials of OraQuick, 1 of every 12 positive tests turned out to be a false negative.

Needless to say, it’s risky for people who are infected with HIV to suddenly believe or feel confident that they don’t have HIV.

The Value of This Test for You

The OraQuick test can be used at home as a screening test for HIV. If you perform the home test and it turns out to be positive, then it’s crucial that you 1) seek medical care and 2) have a second, confirmatory test done.

If subsequent tests by medical professionals confirm that you actually do have HIV, then early and consistent treatment is the key to your being able to live with the HIV virus and protecting others that you risk infecting. Appropriate counseling and support are also an important part of this virus’s treatment and they also make it necessary that you seek further care.

If your home test is negative, then you should repeat it in a month or two, and then again at 6 months, to verify the result and to make sure that in the meantime you have not converted to a positive HIV status. It is important to always practice safe sex, avoid used or contaminated needles, and (if you are yourself a member of a healthcare profession) practice universal precautions. See your healthcare provider if you have any concerns.