HIV Serologic Test Result Interpretive Guide Test Ordering Guidelines Asymptomatic ■ High-risk group or possible exposure: Order Test #1. If Test #1 is negative, consider HIV-1 RNA detection/quantification test (HIVQU) or HIV-1 proviral DNA test (PHIV). Symptomatic ■ ■ Acute HIV infection: Order Test #1. If Test #1 is negative, consider HIV-1 RNA detection/quantification test (HIVQU) or HIV-1 proviral DNA test (PHIV). AIDS-related opportunistic infections: Order Test #1. To predict HIV-1 disease progression, order HIV-1 RNA detection/quantification test (HIVQU). Automatic reflex testing ■ ■ ■ ■ Test #2 will be performed if Test #1 result is Reactive. Test #3 will be performed only if Test #2 result is Indeterminate only for HIV-1 Ab. Both Tests #3 and #4 will be performed if Test #2 result is Reactive or Unreadable for both HIV-1 and HIV-2 Ab. Test #5 will be performed if Test #2 result is Reactive only for HIV-2 Ab. Test Number 1 2 3 4 HIV-1/-2 Ag and Ab Screen HIV-1/-2 Ab Differentiation HIV-1Ab HIV-2 Ab HIV-1 Ab Western Blot HIV-2 Ab Confirmation Interpretation HIV-1 Infection HIV-2 Infection – NT NT NT NT No No R – – NT NT No1 No R + – NT NT Yes2 No R IND – – NT No1 No R IND – + NT Yes No R IND – IND or U NT No1 No R R R + – or IND Yes No R R R + + Yes3 Yes3 R R R – or IND + No Yes4 R R R – or IND – No1 No R R R IND or U IND No1 No R R R U + No Yes4 R R R U IND No1 No R U U + – or IND Yes No R U U + + Yes3 Yes3 R U U – or IND + No Yes4 R U U – or IND – No1 No R U U IND or U IND No1 No R U U U + No Yes4 R U U U IND No No R – + – + No Yes4 R – + – – or IND No No5 1 Ab=Antibody; Ag=Antigen; IND=Indeterminate; NT=Not tested; R=Reactive; U=Unreadable 1 Consider HIV-1 RNA detection / quantification test in high-risk individuals who may have acute or very early HIV-1 infection (ie, <14 days from exposure). 2 Presumptive HIV-1 infection. Submit another specimen for HIV-1 RNA detection/quantification test (preferred) and/or HIV-1 Ab Western blot. 3 Possible dual HIV-1 and HIV-2 infection. Submit another specimen for both HIV-1 RNA detection/quantification test and HIV-2 DNA/RNA qualitative test (FHV2Q). 4 Probable HIV-2 infection. Submit another specimen for HIV-2 DNA/RNA qualitative test (FHV2Q). 5 Consider HIV-2 DNA/RNA qualitative test (FHV2Q) in high-risk individuals who may have acute or very early HIV-2 infection (ie, <14 days from exposure). © Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. MAYO, Mayo Medical Laboratories and the triple-shield Mayo logo are trademarks and/or service marks of MFMER. 11/2014
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