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When to Test for HIV: Here's What to Know

Written on February 19, 2024 by Jillian Foglesong Stabile, MD, FAAFP. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

Human immunodeficiency virus (HIV) is an infectious virus that can be spread through contact with bodily fluids like blood and semen. This virus attacks the immune system and can lead to acquired immunodeficiency syndrome (AIDS).[1] HIV originated as early as the late 1800s in chimpanzees in Central Africa. It began to be seen in the United States in the mid to late 1970s.

In the United States, an estimated 1.2 million people have HIV, and more than 150,000 of them may not realize that they are infected.[2] Over 30,000 people in the U.S. receive a diagnosis of HIV each year. With the infection being this common, you may be wondering when to test for HIV.

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Risk Factors for HIV

HIV can affect anyone of any age, race, ethnicity, or gender. However, certain factors can increase your risk of becoming infected, including [3]:

  • Having unprotected vaginal or anal intercourse, especially with multiple partners
  • Having another sexually transmitted infection such as gonorrhea, chlamydia, syphilis, or herpes
  • Using drugs, especially intravenous drugs
  • Using drugs or alcohol of any kind prior to sexual activity
  • Being a man who has sex with men
  • Being born to a mother with HIV, especially if the mother wasn’t treated for HIV during pregnancy and breastfeeding

Stages of HIV Infection

HIV infection occurs in stages: acute infection, chronic infection, and AIDS.[4]

Acute HIV Infection

Acute HIV infection is the earliest stage of the infection and occurs in the first few weeks. During this stage, the virus multiplies quickly and spreads through the body attacking the immune system. You may have flu-like symptoms, including [5]:

  • Fever
  • Muscle aches
  • Sore throat
  • Night sweats
  • Mouth sores
  • Swollen lymph nodes
  • Diarrhea

Chronic HIV Infection

Chronic HIV infection can last for years. This stage of the infection doesn’t generally cause any symptoms. HIV continues to multiply in the body, but the rate is much lower. Without treatment, HIV can take 10 years or more to advance to AIDS, but this can be faster in some people. With treatment, it can take several decades to progress to AIDS. While it is always possible to spread HIV to others during any stage, treatment decreases the risk of transmitting the virus. If you respond well to treatment and your viral load is undetectable, the risk of transmission drops to almost zero.[6]

AIDS

When HIV progresses to its most advanced form, AIDS is the result. HIV severely damages the immune system. This diagnosis is made when the counts of certain immune cells in the body (CD4) drop below 200 cells/mm^3.[4] AIDS is also diagnosed if certain infections are present [7]:

  • Recurrent bacterial infections including pneumonia
  • Recurrent yeast infections
  • Invasive cervical cancer
  • Coccidioidomycosis
  • Cryptococcosis outside of the lungs
  • Chronic intestinal cryptosporidiosis
  • Cytomegalovirus or cytomegalovirus retinitis
  • HIV encephalopathy
  • Chronic herpes ulcers
  • Histoplasmosis outside of the lungs
  • Burkitt lymphoma
  • Kaposi sarcoma
  • Certain types of mycobacteria
  • Pneumocystis jirovecii
  • Progressive multifocal leukoencephalopathy

AIDS is associated with weight loss, fever, sweats, rashes, swollen lymph nodes, and other symptoms specific to the types of infections that may be present.

Testing Options for HIV

Testing options include the 4th generation test, which looks for the antibodies your body forms to fight against HIV (both types 1 and 2) and also for the p24 antigen. This allows for earlier detection of the virus.[8] If testing is positive, confirmatory testing is done to ensure accurate results. Outside of the normal clinical environment, oral swab rapid testing through enzyme-linked immunosorbent assay (ELISA) antibody testing is sometimes done with additional confirmatory testing. This allows for community access to testing outside of the normal clinical environment.

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When to Get Tested for HIV

All of this information brings us back to our original question, when should you be tested for HIV? Even if you are in the lowest risk category, you should get tested. The Centers for Disease Control and Prevention (CDC) recommends getting tested at least once if you are between the ages of 13 and 64.[9]

Screening in Higher-Risk Individuals

If you are at increased risk of becoming infected with HIV, then you should get tested at least once a year. Some of these risk factors include [9]:

  • Being a man who has sex with men
  • Having anal or vaginal sex with someone with HIV
  • Having more than one sex partner since your last HIV test
  • Sharing needles, syringes, or other equipment for drug injection
  • Exchanging sex for drugs or money
  • Having had another sexually transmitted disease
  • Having been diagnosed with hepatitis or tuberculosis
  • Having sex with someone who is high-risk or whose sexual history you don’t know

Screening in Pregnancy

People who are pregnant should be tested for HIV in early pregnancy. Treatment in pregnancy can help prevent transmission to the baby during pregnancy and delivery. If you are at a high risk for exposure to HIV, you should be retested in the third trimester.[10]

Testing After Exposure

If you’ve been exposed to HIV, you should seek care immediately. Certain medications can be used after exposure to try to decrease the risk of becoming infected (post-exposure prophylaxis). Antibody testing for HIV can find HIV antibodies 23-90 days after exposure. Antigen/antibody combination testing can detect HIV between 18 and 90 days after exposure depending on which tests are performed. Nucleic acid testing (NAT) can detect HIV as soon as 10 days after exposure. If initial testing is negative, healthcare providers recommend retesting after the window period for the test you’ve had done.[11]

Know Your Status With Everlywell

STDs can have a long-term impact on your health. If untreated, STDs can cause serious health conditions and, in some cases, can be life-threatening. Everlywell has a range of testing options available as well. Consider HIV testing and other testing through our at-home lab testing membership to help you take control of your health. We also have clinicians who can provide telehealth visits to discuss your situation and advise you on how to protect yourself.

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References

  1. About HIV. Centers for Disease Control and Prevention. Published June 30, 2022. Accessed February 12, 2024. Medical Citation URL
  2. U.S. Statistics. HIV.gov. Published December 7, 2023. Accessed February 12, 2024. Medical Citation URL
  3. What factors make HIV more likely? Eunice Kennedy Shriver National Institute of Child Health and Human Development. Published August 10, 2021. Accessed February 12, 2024. Medical Citation URL
  4. HIV Overview- The stages of HIV infection. NIH.gov. Published August 20, 2021. Accessed February 12, 2024. Medical Citation URL
  5. What is HIV and AIDS? Penn Medicine. Published on May 19, 2023. Accessed February 12, 2024. Medical Citation URL
  6. Albert J, Berglund T, Gisslen M, et al. Risk of HIV transmission from patients on antiretroviral therapy: A position statement from the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy. Scand J Infect Dis. 2014; 46(10):673-677. Medical Citation URL.
  7. Justiz Vaillant AA, Gulick PG. HIV and AIDS syndrome. StatPearls. Published September 20, 2022. Accessed February 12, 2024. Medical Citation URL
  8. Huynh Katie, Kahwaji CI. HIV Testing. StatPearls. Published April 17, 2023. Accessed February 12, 2024. Medical Citation URL
  9. HIV – Getting Tested. Centers for Disease Control and Prevention. Published June 22, 2022. Accessed February 12, 2024. Medical Citation URL
  10. Timoney MTT, McGowan JP, Fine SM, et al. HIV testing during pregnancy, at delivery, and postpartum. Baltimore (MD): Johns Hopkins University; 2022 Sep. Available from: Medical Citation URL
  11. Understanding the HIV Window Period. Centers for Disease Control and Prevention. Published June 22, 2022. Accessed February 12, 2024. Medical Citation URL
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