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An estimated 1 million people in the United States are infected with HIV. Approximately 40,000-80,000 new infections are diagnosed each year.
The first step in diagnosis is an enzyme-linked immunosorbent assay (ELISA) to detect HIV antibodies.
If the ELISA is positive, the result is confirmed with a Western blot test, which is much more specific. The HIV RNA test has replaced the ELISA.
There is a window period between infection with HIV and the development of antibody levels; within 6 months of infection, 95% of those infected have detectable antibody.
Initial Clinical Evaluation of the HIV-Infected Patient
History of acute HIV illness, fever, symptoms of opportunistic infections, weight loss, oral, gastrointestinal, pulmonary or dermatologic symptoms should be assessed. The date and mode of seroconversion should be determined.
The history also includes hospital visits, operations, immunizations, drug allergies, prior infectious diseases (including hepatitis, sexually transmitted diseases), sexual and drug-use history, medication use now and previously (especially dosage, duration and results of antiretroviral therapy), and social history. The patient's place of birth and lifetime travel history should be recorded to assess of tuberculosis, and histoplasmosis.