HIV Self-Test Approved for All Approval by Healthcare Professionals

Despite certain risks, virologists are in favor of HIV self-testing

The introduction of an HIV self-test could significantly reduce the number of unreported cases of HIV infection, according to experts from the Society for Virology (GfV). In a press release on the occasion of World AIDS Day, the association explains the advantages and disadvantages of the HIV self-test.

Rapid self-testing HIV antibody detection has been approved in several countries for several years. "Background is the desire that as many infected as possible early on know of their infection," says the GfV. Introducing the HIV self-test could significantly reduce the proportion of patients who experience HIV infection at the AIDS stage, and therefore have a poorer outcome, and at the same time increase the risk of infection from people with unrecognized and untreated infection. decrease, so the reference of the professional society.

So far HIV self-tests are not permitted in Germany for private individuals, but they could contribute, according to experts to a significant reduction in unreported cases. (Image: gamjai / fotolia.com)

High number of unreported cases of HIV infections

In Germany, around 88,400 people were living with HIV at the end of 2016, and an estimated 12,700 of those affected did not know that they were infected with the HIV virus, according to the GfV's statement citing the figures of the Robert Koch Institute (RKI). The high number of unreported cases is problematic for two reasons. Because on the one hand, the therapy should start as early as possible after the infection and on the other hand, these people could inadvertently infect other people. With the approval of an HIV self-test, similar to the pregnancy tests, which can be carried out at home, according to the experts, a reduction in the number of unreported cases could be achieved.

Certain risks of self-testing

In a recent statement, the GfV therefore opted in principle for the approval of HIV self-tests. However, the experts also point to certain risks associated with the tests. These should be "minimized as far as possible." med. Josef Eberle from the Max von Pettenkofer Institute of the Ludwig-Maximilians-University Munich emphasizes in a press release of the "Association of the Scientific Medical Societies eV" that despite the many, even anonymous and free offers for an HIV test, not all infected people reached become.

Tax on individuals prohibited so far

"It is noticeable that for more than one quarter of HIV new diagnoses, the infection has not been detected until the patient is already ill or the number of T helper cells is below 350 / μl, which corresponds to an advanced HIV infection ", Says Prof. Eberle. According to the expert, the self-test offers good opportunities for improving the early diagnosis rate. However, such a test in Germany may not yet be made to private individuals. However, it is currently being examined whether the medical devices levy regulation should be amended accordingly.

Good experience with the HIV self-tests

Initial experience from England, where the test is already approved, are promising, according to the GfV. The test is easy to handle and panic reactions as a result of false positive test results are hardly reported. Nevertheless, there are certain problems, according to the GfV. This applies, for example, in terms of the quality of the self-tests. For example, "HIV rapid tests using CE markers that use fingertip blood are quite similar to fourth generation HIV laboratory tests," but they remain inferior to laboratory tests for detection of infection when they are at a very early stage infection, explains Prof. Eberle.

Test result is not always reliable

The limited reliability of the test results may result in those affected likely to be in false positives, "and at a time when transmission risk is particularly high," the expert said. This risk is even more so in self-tests that use not blood, but a special oral swab (oral fluid) as a test material. According to the virologist, the problem is also a possible misinterpretation of the test results by the users. Because only three months after a possible infection the self-test deliver a sure result. Previous tests were only conditionally meaningful. In addition, according to the experts, the tests always show a certain error rate, so that a positive or negative result can be quite wrong. Therefore, in the case of a test in the specialist laboratory, the result is checked by means of a confirmation test before information is given to those affected.

Tax required to private individuals

Despite the concerns, the submission of self-tests to private persons in the opinion of the GfV experts is to be advocated "to prevent the further spread of HIV infection and allow infected people to start early therapy." However, it must be "guaranteed that the tests clear Information on handling the results is included, "says Professor Eberle. This also includes the reference to "the three-month deadline and the possible error rate, as well as the recommendation, in the case of a positive or unclear finding, to have it reviewed again with a laboratory-based procedure and, if necessary, to seek psychological help."

Furthermore, according to the GfV, users of the HIV self-test should be informed that the possibility of post-exposure prophylaxis (PEP) from HIV medications exists up to 72 hours after a possible infection. In addition, the GfV advocates that, when the tests are approved, the effectiveness be scientifically supported by the parameters "new infections" and "proportion of patients with a later diagnosis". (Fp)