Dr Sean Cummings Freedomhealth London UK Identifying early or acute HIV infection is crucial in preventing inadvertent onward transmission to other HIV negative people and slowing disease progression in newly HIV positive people. The HIV RNA PCR test allows for the earliest diagnosis possible.

Early identification of new infections of HIV will limit onward spread of HIV by more than 50%. That's the conclusion of a number of researchers whose work has helped underpin the New York State Department of Health AIDS Insitute recent update on the Diagnosis and Management of Acute HIV Infection.

Dr Sean Cummings of London's Freedomhealth Clinic said "Identifying early or acute HIV infection is crucial in preventing inadvertent onward transmission to other HIV negative people and slowing disease progression in newly HIV positive people. The HIV RNA PCR test allows for the earliest diagnosis possible and this is then always followed with confirmatory testing".

Freedomhealth has partnered with The Doctors Laboratory to launch this new HIV 1 and 2 RNA PCR test via the Freedomhealth Clinic in Central London or by post from anywhere around the world.

A number of factors act to increase the risk of HIV transmission during the acute or very early phase of the disease. These include the fact that many people will be unaware that they have contracted the disease and will maintain risky sexual behaviour with other, currently HIV negative individuals. Newly HIV positive people will have very high initial "viral loads" (the amount of HIV virus in their blood, vaginal secretions and also semen). Finally, the earliest symptoms of HIV are very often non specific and go un-noticed.

Doctors in all settings including primary care physicians and emergency department doctors as well obviously as Sexual Health specialists should have a high index of suspicion to ensure prompt recognition of early HIV disease. Acute HIV infection is often referred to as ARS (Acute Retroviral Syndrome) or sometimes referred to as a "seroconversion illness" where someone moves from being HIV antibody negative to HIV antibody positive. The change from one to another is often accompanied in up to 70% of people by a classic triad of early HIV symptoms comprising very high fever, very sore throat and a whole body rash. These patients need to be considered for a number of diseases including glandular fever (infectious mononucleosis), a streptococcal infection of the throat and also of course HIV if they are sexually active or inject recreational drugs.

HIV testing at an early stage is imperative in order to limit further onward spread of HIV and also to facilitate potential early HIV treatment and screening for other sexually transmitted diseases which may co-exist.

Plasma HIV RNA PCR testing allows for very early identification of new HIV infection well before antibody tests may become positive. Typically, after HIV infection, HIV antibodies take 2 to 6 weeks to form and be detectable. The detection of antibodies will vary depending on the individual patient's immune system but also on the quality of the HIV test and which generation HIV test is used. Modern third generation HIV tests will identify more than 99% of newly acquired HIV infection by 6 weeks post exposure.

Fourth generation combined HIV 1 and 2 antibody plus p24 antigen tests are extremely accurate and will identify greater than 99.8% of new HIV infection by 28 days post exposure. These 4th generation HIV tests have been in widespread use in Western Europe for the best part of a decade but have only just achieved US FDA approval for use in the USA. The availability of HIV testing and the quality or generation of HIV test devices across the USA varies significantly with some areas until very recently offering poor 1st generation HIV antibody tests and many others offering 2nd generation. By contrast, the UK has 4th generation HIV testing as the basic standard test method.

The acccuracy of HIV RNA PCR testing dramatically shortens the interval from infection to testing from 28 days to a minimum of 7 days following exposure. This means that newly infected HIV positive people can be successfully identified and the inadvertent onward transmission process terminated before others are infected.

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