Part two: does your teen need a rapid screening or PCR test for HIV?

June 11, 6:47 PMBaltimore Family Health ExaminerNancy Eason

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AP Photo/Mark Humphrey

Allison Agwu, M.D., a pediatric infectious disease specialist at Johns Hopkins Children's Center in Baltimore, has concerns that the commonly used HIV antibody test can be fickle for early infections in teens. "If a teen engages in risky behaviors and has symptoms of flu or mononucleosis, pediatricians should look further and not be lulled into a false sense of security by a negative rapid HIV test," cautions Dr. Agwu.

Here's what Dr. Agwu says may happen in the community: A teenager who is typically healthy goes to the doctor's office with a sore throat, a fever, aches and just generally feeling bad. The routine blood tests and an HIV test are negative, so the doctor makes a diagnosis of an acute viral infection and sends the teen on her way. In two weeks, she comes back with symptoms that are hanging on along with high fevers. A repeat HIV test comes back positive. How is this possible?

Dr. Agwu explains that the rapid HIV test had a false negative the first time because rapid HIV screening tests are meant to find antibodies to the virus -- not the virus itself. This happens often during the earliest and most contagious stages of HIV infection, known as acute retroviral syndrome (ARS). Most people do not make antibodies to the virus until several weeks to several months after infection.

Rather than using the rapid HIV, doctors can order a polymerase chain reaction (PCR) test, which detects the HIV genetic markers -- not the antibodies. The PCR also can find the virus within two to three weeks after entering the body.

For teens who are sexually active or have used injectable drugs and have two or more of the following symptoms, doctors are urged to order a PCR test:

* enlarged lymph nodes (key symptom)

* night sweats (key symptom)

* malaise, fatigue, headaches or rash

* fever and chills

* persistent or recurrent sore throat and/or cough

"It is possible that the pediatrician may not be aware of the limitations of the antibody testing in early infections...," says Dr. Agwu. A parent or teen can mention what they've heard on the limitations and ..."that may be all that is needed to alert your pediatrician of the need for additional testing."

See part one: Does your teen need HIV testing? for contact info.