HIV Testing / Screening

Types of HIV Tests Available(Anonymous HIV Testing available)

Time from Exposure

HIV TEST

Time to results

Fees (before GST)

Remarks

Less than 3 days or 72 hours

No testing is available at this stage.
You may wish to consider HIV PEP (Post Exposure Prophylaxis) if you have had a high risk exposure, i.e. unprotected sex with a commercial sex worker or high risk contact, or needlestick injury from a IV drug abuser.

HIV PEP was shown to be >80% effective in reducing risk of HIV infection. In animal studies, it was shown that the earlier (

10 - 14 days

HIV RNA/DNA Polymerase Chain Reaction (PCR) Test

1 - 2 weeks

$600

21 - 28 days
(3 - 4 weeks)

Rapid Fingerprick Blood HIV-1/2 P24 Antigen/Antibody Combo (HIV Duo Test) (4th generation)

20 min

$85

Recommended by UK Guidelines in HIV Testing 2008 - conclusive at 28 days post exposure.

More than 28 days (> 4 weeks)

HIV Antibody Test (ELISA)

Rapid Oral Saliva HIV-1/2 Antibody Test (Oraquick)

Rapid Fingerprick Blood HIV-1/2 Antibody Test (Determine)

1 - 3 days

20 min

20 min

$35

$55

$55

Results are 90% accurate at 1 month post exposure
Results are >99% accurate at 3 months post exposure

Anonymous HIV Testing

Kensington Family Clinic is an approved Anonymous HIV Testing Site, licensed by the Ministry of Health Singapore. If you wish to do anonymous HIV Testing, simply mention "AHT", or anonymous testing and our staff will know what to do. No names, no identification and no registration details required.

What is HIV Testing/Screening?

Depending on your sexual exposure and time from exposure, different HIV screening tests may be required or recommended. Sexual exposure refers to any type of sexual contact e.g. oral, vaginal or anal intercourse with a high risk contact such as a commercial sex worker or people with risky sexual behaviour. Use of barrier protection methods such as condoms greatly reduces your risk but it is not 100%. There is always a risk whenever there is skin or mucosal contact with HIV-contaminated genital fluids or blood.

What are HIV symptoms?

Unfortunately, HIV is frequently asymptomatic ( that is, it displays no symptoms ) until the late stages, where AIDS ( Acquired Immunodeficiency Syndrome ) may already be evident.

Early symptoms may occur, usually within 1 to 4 weeks of infection. This is termed seroconversion illness and typically presents with flu-like symptoms, such as fever, bodyaches, swollen neck glands and running nose. These symptoms subside, even without treatment, in a few weeks.

As the infection progresses and the immune system weakens, other symptoms may subsequently appear. The time taken for this to occur may stretch as long as 10 years, or even more.

The later symptoms may include :-

Lack of energy and tiredness
Weight loss
Fever or night sweats
Persistent or unusual skin rashes
Recurrent and severe flare-ups of herpes
Recurrent and severe yeast or fungal infections
Cough or shortness of breath
Seizures and lack of coordination
Difficult or painful swallowing
Mental symptoms such as confusion and forgetfulness
Severe and persistent diarrhea
Vision loss

As patients with HIV progresses into full blown AIDS, they also become prone to developing various cancers such as Kaposi sarcoma ( a type of skin cancer ), cervical cancer and lymphomas ( cancers of the immune system ). With AIDS, the survival time if no treatment is given has been estimated to be 2-3 years on average.

What is the risk of getting infected with HIV?

From the US CDC ( Centers for Disease Control and Prevention ) website
Estimated Per-Act Probability of Acquiring HIV from an Infected Source, by Exposure Act^a
Exposure route

Risk per 10,000 exposures

Estimated Risks

Blood Transfusion

9,000b

~1 in 1

Needle-sharing injection-drug use

67c

~ 1 in 150

Percutaneous needle stick

30d

~ 1 in 300

Receptive anal intercourse

50e,f

~ 1 in 200

Receptive penile-vaginal intercourse

10e,f,g

~ 1 in 1000

Insertive anal intercourse

6.5e,f

~ 1 in 1500

Insertive penile-vaginal intercourse

5e,f

~ 1 in 2000

Receptive oral intercourse

1e,i

~ 1 in 10000

Insertive oral intercourse

0.5e,i

~ 1 in 20000
References
Factors that increase the risk of HIV transmission include sexually transmitted infections, early and late-stage HIV infection, and a high level of HIV in the blood.
Factors that reduce the risk of HIV transmission include condom use, male circumcision, and use of antiretrovirals.

Donegan E, Stuart M, Niland JC, et al. Infection with human immunodeficiency virus type 1 (HIV-1) among recipients of antibody-positive blood donations. Ann Intern Med 1990;113(10):733-739.

Kaplan EH, Heimer R. A model-based estimate of HIV infectivity via needle sharing. J Acquir Immune Defic Syndr 1992;5(11):1116-1118.

Bell DM. Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview. Am J Med 1997;102(5B):9-15.

Varghese B, Maher JE, Peterman TA, Branson BM, Steketee RW. Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use. Sex Transm Dis 2002;29(1):38-43.

European Study Group on Heterosexual Transmission of HIV. Comparison of female to male and male to female transmission of HIV in 563 stable couples. BMJ 1992;304(6830):809-813.

Leynaert B, Downs AM, de Vincenzi I; European Study Group on Heterosexual Transmission of HIV. Heterosexual transmission of HIV: variability of infectivity throughout the course of infection. Am J Epidemiol 1998;148(1):88-96.

HIV transmission through these exposure routes is technically possible but extremely unlikely and not well documented.

HIV transmission through oral sex has been documented, but rare. Accurate estimates of risk are not available.

Pretty LA, Anderson GS, Sweet DJ. Human bites and the risk of human immunodeficiency virus transmission. Am J Forensic Med Pathol 1999;20(3):232-239.
From the Canadian AIDS Treatment Information Exchange:

Risk of HIV Transmission From Different Types of Unprotected Sex

Number of Individual Studies

Range of Estimates

Meta-Analysis Estimate

Receptive anal

4

40.4%-3.38%

1.4%

Insertive anal

2

0.06%-0.62%

--

Receptive vaginal

10

0.018%-0.150%

0.08%

Insertive vaginal

3

0.03%-0.09%

0.04%
From this UK-based patient information website, NAM ( National AIDS Manual ):
Estimated HIV transmission risk per exposure for specific activities and events
Activity

Risk-per-exposure

Vaginal sex, male-to-female, studies in high-income countries

0.04% (1:2380)

Vaginal sex, female-to-male, studies in low-income countries

0.08% (1:1234)

Vaginal sex, male-to-female, studies in low-income countries

0.38% (1:263)

Vaginal sex, male-to-female, source partner is asymptomatic

0.30% (1:333)

Vaginal sex, male-to-female, source partner has late-stage disease

0.07% (1:1428)

Receptive anal sex amongst gay men, partner unknown status

0.55% (1:180)

Receptive anal sex amongst gay men, partner HIV positive

0.27% (1:370)

Receptive anal sex with condom, gay men, partner unknown status

0.82% (1:123)

Insertive anal sex, gay, partner unknown status

0.18% (1:555)

Insertive anal sex with condom, gay men, partner unknown status

0.06% (1:1666)

Receptive fellatio

Estimatesrange from 0.00% t0 0.04% (1:2500)

Mother-to-child, mother takes at least two weeks antiretroviral therapy

0.08% (1:125)

Mother-to-child, mother takes combination therapy, viral load below 50

0.01% (1:1000)

Injecting drug use

Estimates range from 0.63% (1:158) to 2.4% (1:41)

Needlestick injury, no other risk factors

0.13% (1:769)

Blood transfusion with contaminated blood

92.5% (9:10)

Sources: vaginal sex;¹ anal sex;² fellatio;³ ² mother-to-child;⁴ other activities.⁵
References
Boily MC et al. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. Lancet Infect Dis 9(2): 118-129, 2009

Vittinghoff E et al. Per-contact risk of human immunodeficiency virus transmission between male sexual partners. American Journal of Epidemiology 150: 306-311, 1999

Del Romero J et al. Evaluating the risk of HIV transmission through unprotected orogenital sex. AIDS 16(9): 1296-1297, 2002

Townsend C et al. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS 22: 973-981, 2008

Baggaley RF et al. Risk of HIV-1 transmission for parenteral exposure and blood transfusion. AIDS 20: 805-812, 2006
Risk Category

Type of Exposure ( assuming partner is HIV positive )

Remarks

Very high risk

Blood transfusion of infected blood

Needle sharing amongst IV drug users

Receptive anal sex

>90%

0.67%

0.4% - 3.38%

Moderate to high risk

Receptive vaginal sex

Insertive anal sex

Insertive vaginal sex

0.08% to 0.19%

0.06% - 0.62%

0.03% - 0.1%

Low risk

Receptive oral sex

Extremely rare

Negligible / Theoretical risk

( theoretically possible but extremely unlikely and no well-documented cases )

Insertive oral sex

'Rimming' / Peri-anal licking

Sharing sex toys

Biting

Spitting

Throwing body fluids eg. semen/saliva

No documented cases; carries risk of other STIs if unprotected

Carries risk of other STIs

Carries risk of other STIs

Risk of wound infection

Factors which increase the risk

Presence of a concomitant STI

Presence of sores or wounds or ulcers

High viral load in partner

Presence of ejaculation ( for receptive partner )

>90%

0.67%

0.4% - 3.38%

Factors which reduce the risk

Anti-retroviral ( ARV ) treatment in affected partner

Consistent and correct condom use

Male circumcision

96% reduction(1)

80% reduction(2)

50-60% reduction ( female-to-male )
Cohen MS, Chen YQ, McCauley M, et al; HPTN 052 Study Team. Prevention of HIV-1 Infection with early antiretroviral therapy. N Engl J Med2011;365(6):493-505.

Weller SC, Davis-Beaty K. Condom effectiveness in reducing heterosexual HIV transmission (Review). The Cochrane Collaboration. Wiley and Sons, 2011.

What happens if my HIV test is positive?

If the initial screening test is positive, a second blood sample will need to be sent for a confirmatory test called the Western Blot. This test typically takes about 2 weeks to be ready. No fasting or other special preparation is required.

The Western Blot may show:

Negative ( good news! But consider repeating antibody test in 3 months if there has been risk of exposure )
Indeterminate ( Consider repeating antibody test or P24 Combo test in 1 month if there has been risk of exposure )
Positive ( Our doctor will discuss the subsequent options for treatment and follow up with you ). If the Western Blot confirms the presence of HIV infection, you will be referred to the Communicable Disease Centre ( of Singapore ) for further management. Alternative centres for treatment are also available in the major tertiary hospitals in Singapore. It is important that you understand relatively effective medications are available for the control of HIV. The key to obtaining a better outcome is to seek treatment and follow-up early.

At Kensington Family Clinic, HIV testing is fully anonymous. No names or registration details are required, even if you are tested positive on confirmatory Western Blot testing.

HIV is certainly a serious infection, but options now exist for patients to have the infection suppressed and controlled. This can help reduce or delay the late complications of HIV infection and help protect your sexual contacts from HIV. Therefore it is crucial to take the first step and be tested.