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HIV infection and AIDS - Diagnosis
Last reviewed: 06.07.2025
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Indications for consultation with other specialists
Before highly active antiretroviral therapy (HAART), all patients with HIV infection are examined by a therapist, neurologist, otolaryngologist and ophthalmologist to determine contraindications to the prescription of certain drugs. In addition, patients who have previously used or are constantly using psychoactive substances are referred for consultation to a narcologist. All patients with pulmonary pathology, especially if antibacterial therapy is ineffective, are examined by a phthisiopulmonologist. Consultations with other specialists are carried out according to indications, depending on the identified pathology (secondary or concomitant diseases), to determine the scope of additional examinations or to decide on transferring the patient to a highly specialized department or hospital.
Clinical diagnostics of HIV infection
Correct diagnosis of HIV infection is based on laboratory confirmation. Clinical diagnosis of secondary or concomitant diseases against the background of HIV infection is carried out: this allows determining the severity of the patient's condition, indications for hospitalization and developing treatment tactics.
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Specific and non-specific laboratory diagnostics of HIV infection
To clarify the diagnosis of HIV infection, immunoblotting is performed in AIDS prevention and control centers. Virological, molecular genetic (PCR) and serological methods (ELISA) and immunoblotting are used to confirm the diagnosis of HIV infection.
Antibodies to HIV are determined after 2 weeks from the moment of infection. When the first positive result is registered using ELISA, the analysis is duplicated. After receiving the second positive response, this blood serum is sent for testing to the Center for Prevention and Control of AIDS, where immunoblotting is performed. The results of immunoblotting are assessed as positive, questionable or negative.
If antibodies to any two or three HIV envelope glycoproteins (gp41, gp120, and gp160) are detected in the patient's blood serum simultaneously, the samples are considered positive. If antibodies to all antigens are not detected in the blood serum, the samples are considered negative. If antibodies to one HIV glycoprotein or any of its proteins are detected in the blood, the samples are considered questionable and require repeated testing.
Isolation and identification of HIV culture (virological method) is a reliable criterion for assessing infection. Due to the complexity of the procedure, this study is used only in cases that are extremely difficult to diagnose.
The quantitative version of PCR allows to evaluate the replicative activity of the virus; to determine the "viral load". At the stage of primary manifestations, the "viral load" is usually several thousand copies in 1 ml of blood. At the stage of secondary diseases, the HIV level reaches hundreds of thousands of copies in 1 ml of blood serum and a million copies of the virus in AIDS.
A persistently high concentration of HIV in the early stages of the disease is an unfavorable prognostic sign, indicating the extreme aggressiveness of the virus.
Primary diagnosis of HIV infection is a responsible procedure that requires careful analysis of data, since an incorrect diagnosis can have serious consequences for the patient (depressive reaction, suicide attempt, AIDS phobia).
Laboratory confirmation of the diagnosis is mandatory. Most often, antibody detection methods are used (first in ELISA, then in immunoblotting). If the immunoblotting result is questionable, the patient needs to undergo follow-up and re-examination.
Standard for the diagnosis of HIV infection
Detection of antibodies to the immunodeficiency virus using ELISA followed by confirmation of their specificity by immunoblotting is a standard procedure.
Example of diagnosis formulation
When making a diagnosis, the nosological unit of the disease is indicated - HIV infection according to ICD-10. Then - the stage of HIV infection, phase and secondary diseases. If against the background of HIV infection at least one of the secondary diseases has a degree of manifestation corresponding to the criteria of acquired immunodeficiency syndrome, then after the phase of the disease AIDS is indicated.
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For example
Z21. HIV infection, stage III (subclinical).
B20.4. HIV-associated disease with manifestations of candidiasis.
HIV infection, stage IVA, remission phase. Oropharyngeal candidiasis (history).
B20.6. HIV-associated disease with manifestations of Pneumocystis carinii pneumonia.
HIV infection, stage IVB, progression phase (AIDS). Pneumocystis pneumonia, oral and esophageal candidiasis.
B20.2. HIV-associated disease with manifestations of cytomegalovirus disease.
HIV infection, stage IVB, remission phase (AIDS). Manifest cytomegalovirus infection with retinal damage (in anamnesis).
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