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PARTICIPANTS Jeffrey Laurence, MD Medical College of Cornell University, Senior Scientific Consultant for programs of the American Foundation for AIDS Research (amfAR)

Jeffrey Laurence: There are two major classes of tests for HIV. You can test for the virus itself. It's an AIDS virus test. You can test for antibodies against the virus. Antibodies against the virus we can test them in three fluids. We can test them in blood, saliva, urine and the two major kinds of antibody tests we do a relatively easy test called an ELISA and if that's positive, then we follow it up with a confirmatory Western blot test.

Announcer: But though the results of HIV testing are critically important, the current process has some flaws. One problem is the time it takes to get the results.

Jeffrey Laurence: You come in. You have a tube of blood drawn. Some people are upset about even getting a tube of blood drawn if they haven't had it done before. You have to wait for the test results an ELISA test, that's typically a week. And if the ELISA test is positive, then you have to do this confirmatory test, and that's going to take another week and one of our biggest issues is that a fair percentage of people never come back to get their test results.

Announcer: But recently the FDA has approved a new rapid HIV test that hopefully will dramatically increase the number of people who will know their HIV status.

Jeffrey Laurence: This new test does not require a tube of blood. It just requires a little finger stick worth of blood and supposedly it can be done in as quickly as 20 minutes.

The new rapid test, the OraQuick, is supposed to be virtually identical in sensitivity and specificity to the standard ELISA test. If you desire to get a quick test, you'd go into a physician's office or a clinic. There are about 40,000 sites in hospitals and clinics that are currently FDA approved to offer this test they'll give you pre-test counseling, just as they would in a standard blood test for HIV and the test is virtually identical to a pregnancy test, the EPT test that you'd buy in a pharmacy. That is, there's a little dipstick that the doctor will dip in, or the nurse or practitioner will dip into that little drop of blood that you've given. If one line appears on that dipstick as it would in a pregnancy test you don't have HIV. If two lines appear, you do have HIV.

Announcer: Many doctors and AIDS advocacy groups are eager to starting using this new test.

Jeffrey Laurence: All those people that get nervous, that come in, get their blood drawn for the regular test and never make it back it's estimated there are somewhere between 8,000 and 10,000 people in the United States a year that never come back for their test results, we'll be able to capture those people, because they can certainly sit there for 20 minutes. If it's a positive test they'll need to come back for a confirmatory test, but this is a very accurate test.

Presumably then those individuals given appropriate post test counseling, will not spread this virus to other individuals, will perhaps make a decision to see a physician about drug treatment for their HIV, about preventative measures they can take for spreading the virus and from acquiring infections that people get with HIV disease, and so in that sense I think it's a very important test.

ANNOUNCER: And since effective treatments can improve the long-term outcome of people infected with the virus, the rapid test could be useful in many situations.

Jeffrey Laurence: In the United States there is very, very little mother to infant transmission of HIV, and that's because the vast majority of people in the United States, women get some level of prenatal care. However, what happens if a woman comes into the delivery room, and you'd love to know is this a woman that you should try to give an antiretroviral pill to on the delivery table because we know that if you give one dose of a pill to a woman in labor, and then one dose of that same pill to a baby within 48 hours of delivery, that we can reduce the mother to fetal transmission of AIDS by about 70% by one pill.

There's also the issue of hundreds of thousands of accidental needle sticks among health care workers in the United States each year. Luckily the numbers of transmissions of HIV to health care workers have been minimal, but still, if you're the person and you want to know whether you need to take antiretroviral therapy, you're not really going to wait. You could do this quick test and within 20 minutes decide whether you want to go on rapid antiretroviral therapy.

ANNOUNCER: While there is much enthusiasm over this new test, there is a potential for misuse.

Jeffrey Laurence: If it's abused there have to be safeguards. We don't want, you know, some employer to decide gee, this is so interesting. They'll get a very small amount of blood removed from some other blood test and get these little cards and start, you know, testing their employees or start testing their lovers or friends or whatever. There have to be safeguards and I'm concerned about the fact that this is so relatively easy that people who are not well trained in laboratory diagnosis, might be using these things and falsely report out a test so I want to make certain that people have appropriate training.

ANNOUNCER: Ultimately health care professionals feel confident this newest testing technique, can help reduce the number of people who unknowingly carry the HIV virus.

Jeffrey Laurence: I think that we should be testing many, many more people in the United States for HIV.

The CDC estimates that in the United States, there are about 900,000 people infected with HIV and they also estimate that only about 50% of them know it.

I think there are lots of reasons why people don't want to be tested. Now that we have effective treatments for the HIV virus, so that many people are living long lives with HIV, people should know that we have something available if we tell them they're positive. And I would like to see the HIV test, and perhaps this HIV test, because it's so rapid, used routinely.