AIDS Health Article

Diagnosis

Because HIV infection produces such a wide range of symptoms, the CDC has drawn up a list of 34 conditions regarded as defining AIDS. The physician will use the CDC list to decide whether the patient falls into one of these three groups:

• definitive diagnoses with or without laboratory evidence of HIV infection
• definitive diagnoses with laboratory evidence of HIV infection
• presumptive diagnoses with laboratory evidence of HIV infection

Physical findings

Almost all the symptoms of AIDS can occur with other diseases. The general physical examination may range from normal findings to symptoms that are closely associated with AIDS. These symptoms are hairy leukoplakia of the tongue and Kaposi's sarcoma. When the doctor examines the patient, he or she will look for the overall pattern of symptoms rather than any one finding.

Laboratory tests for HIV infection

BLOOD TESTS (SEROLOGY). The first blood test for AIDS was developed in 1985. At present, patients who are being tested for HIV infection are usually given an enzyme-linked immunosorbent assay (ELISA) test for the presence of HIV antibody in their blood. Positive ELISA results are then tested with a Western blot or immunofluorescence (IFA) assay for confirmation. The combination of the ELISA and Western blot tests is more than 99.9% accurate in detecting HIV infection within four to eight weeks following exposure. Indeterminate test results are possible (positive ELISA but non-confirmatory Western blot result) if the tests are given within the window period after infection (up to eight weeks after infection, but may be longer). In these indeterminate cases, the ELISA and Western blot should be repeated every three months until a definitive result is made. The patient should be considered HIV positive until proven otherwise. The polymerase chain reaction (PCR) test can be used to detect the presence of viral nucleic acids in the very small number of HIV patients who have false-negative results on the ELISA and Western blot tests.

OTHER LABORATORY TESTS. In addition to diagnostic blood tests, other blood tests are used to track the course of AIDS in patients that have already been diagnosed, including blood counts, viral load tests, p24 antigen assays, and measurements of [.beta]₂^-microglobulin ([.beta]₂[.Mu]).

Doctors will use a wide variety of tests to diagnose the presence of opportunistic infections, cancers, or other disease conditions in AIDS patients. Tissue biopsies, samples of cerebrospinal fluid, and sophisticated imaging techniques, such as magnetic resonance imaging (MRI) and computed tomography scans (CT) are used to diagnose AIDS-related cancers, some opportunistic infections, damage to the central nervous system, and wasting of the muscles. Urine and stool samples are used to diagnose infections caused by parasites. AIDS patients are also given blood tests for syphilis and other sexually transmitted diseases.