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HIV key points

The Western blot identifies antibodies recognizing specific viral antigens and is
considered positive when any two of the following three antigens are identified:
p24 (capsid), gp41 (envelope), and gp120/160 (envelope).
Most serologic tests in use detect either HIV-1 or HIV-2specific antibodies, and
several salivary and/or rapid blood tests are available with efficacy comparable to
ELISA.8 Patients with early, acute HIV infection may not yet have detectable HIVspecific antibodies; therefore HIV viral load determination should be used for
diagnosing acute HIV infection.9
Any patient suspected of having the acute retroviral syndrome should have a
repeat viral load and serologic assessment in 2 weeks.
Although clinicians in the United States infrequently encounter patients infected
with HIV-2 or a nonclade-B HIV-1 subtype, accurate diagnosis and plasma HIV
RNA (viral load) assessment require assays capable of detecting the virus carried
by the patient.
Thus, consultation with an expert familiar with atypical HIV infection is
warranted when caring for patients with an indeterminate HIV diagnosis and
untreated patients with an undetectable viral load,
particularly if HIV infection was acquired outside the United States

Women should also be counseled about the availability


of highly effective contraceptives, including longterm
reversible methods (implants, injectables, and IUDs)
to be used in conjunction with condoms, to prevent
unintended
pregnancy. Finally, women should be counseled
regarding the potential that the demands of caring for a
new baby could make adherence to ART more difficult;
nonetheless, maintaining adherence can prolong the
effectiveness
of ART.14