HIV in body fluids during primary HIV infection: implications for pathogenesis, treatment and public health

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. 2001 May 4;15(7):837-45.

doi: 10.1097/00002030-200105040-00004.

C D Pilcher 
¹
, D C Shugars, S A Fiscus, W C Miller, P Menezes, J Giner, B Dean, K Robertson, C E Hart, J L Lennox, J J Eron Jr, C B Hicks

Affiliations

Affiliation

• ¹ School of Medicine, University of North Carolina at Chapel Hill, 27599-7030, USA.

• PMID:

  11399956

• DOI:

  10.1097/00002030-200105040-00004

C D Pilcher et al.

AIDS.

2001.

. 2001 May 4;15(7):837-45.

doi: 10.1097/00002030-200105040-00004.

Authors

C D Pilcher 
¹
, D C Shugars, S A Fiscus, W C Miller, P Menezes, J Giner, B Dean, K Robertson, C E Hart, J L Lennox, J J Eron Jr, C B Hicks

Affiliation

• ¹ School of Medicine, University of North Carolina at Chapel Hill, 27599-7030, USA.

• PMID:

  11399956

• DOI:

  10.1097/00002030-200105040-00004

Abstract

Objective:

To describe initial viral dissemination to peripheral tissues and infectious body fluids during human primary HIV infection.

Design:

Observational cohort study.

Methods:

Blood plasma, cerebrospinal fluid (CSF), seminal plasma, cervicovaginal lavage fluid and/or saliva were sampled from 17 individuals with primary HIV infection (range of time from symptoms onset to sampling, 8–70 days) and one individual with early infection (168 days). Subjects’ HIV-1 RNA levels in each fluid were compared with levels from antiretroviral-naive controls with established HIV infection. For study subjects, correlations were assessed between HIV-1 RNA levels and time from symptoms onset. Responses to antiretroviral therapy with didanosine + stavudine + nevirapine +/- hydroxyurea were assessed in each compartment.

Results:

HIV-1 RNA levels were highest closest to symptoms onset in blood plasma (18 patients) and saliva (11 patients). CSF HIV-1 RNA levels (five patients) appeared lower closer to symptoms onset, although they were higher overall in primary versus established infection. Shedding into seminal plasma (eight patients) and cervicovaginal fluid (two patients) was established at levels observed in chronic infection within 3–5 weeks of symptoms onset. High-level seminal plasma shedding was associated with coinfection with other sexually transmitted pathogens. Virus replication was suppressed in all compartments by antiretroviral therapy.

Conclusions:

Peak level HIV replication is established in blood, oropharyngeal tissues and genital tract, but potentially not in CSF, by the time patients are commonly diagnosed with primary HIV infection. Antiretroviral therapy is unlikely to limit initial virus spread to most tissue compartments, but may control genital tract shedding and central nervous system expansion in primary infection.

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How HIV is transmitted | Terrence Higgins Trust

HIV is passed on through blood, semen, vaginal fluid, anal mucus and breast milk, if the person with HIV has a detectable viral load. It’s not passed on by spitting, sneezing or coughing.

Content

Image

How is HIV transmitted?

Text

If someone with HIV has a detectable viral load, they can pass on HIV through the following body fluids:

• blood
• semen (including pre-cum)
• vaginal fluid
• anal mucus
• breast milk.

People can get HIV through:

• vaginal/frontal and anal sex without a condom
• sharing drug injecting equipment
• sharing sex toys
• mother-to-child transmission during pregnancy
• coming into contact with contaminated blood.

Most activities pose no risk of getting or passing on HIV.

HIV cannot be passed on by:

• kissing
• hugging 
• shaking hands
• sharing space with someone
• sharing a toilet 
• sharing household items such as cups, plates, cutlery, or bed linen
• any other general social contact.

How long can HIV survive outside the body?

Text

Once outside the body, HIV usually can’t survive for very long. Coming into contact with blood or semen that has been outside the body doesn’t generally pose a risk for HIV transmission.

Similarly, the risk of passing on HIV to someone else if you have a detectable viral load and cut yourself is also very low. Wash away any blood with soap and hot water and cover the wound with a sticking plaster or dressing.

How do you get HIV from semen or vaginal fluid?

Text

Body fluids including semen and vaginal secretions can contain HIV. If a person has HIV and a detectable viral load, HIV can passed on to someone if their semen or vaginal secretions get into the body of a sexual partner during vaginal or anal sex.

If a man has HIV and a detectable viral load, one of his body fluids where the virus is found is his semen.

If he has a detectable viral load and his semen gets into the body of his sexual partner during sex, then HIV can get into the other person’s bloodstream.

Pre-cum also contains HIV – this is why there is a risk of infection even if a man pulls out of his partner before he ejaculates.

If a woman has HIV and she has a detectable viral load, one of her body fluids where the virus is found is in her vaginal secretions.

If these come into contact with a penis during sex, then HIV could be transmitted. The virus in her secretions can enter through the delicate skin of the penis or foreskin.

Do condoms stop HIV being passed on?

Text

Yes. Using a condom correctly prevents contact with semen or vaginal secretions (and blood), stopping HIV from being passed on. The virus cannot pass through the latex of the condom.

Condoms should only be used with a water-based lubricant as oil-based lube weakens them.

People with HIV who are on effective treatment and have an undetectable viral load cannot pass on HIV through any of their body fluids.

It’s also important to remember that if you have sex without a condom other sexually transmitted infections (STIs) can be passed on.

Sex without a condom can also result in pregnancy if other contraception is not being used.

Mother-to-child transmission

Text

This is now extremely rare in the UK because the following medical interventions reduce the risk of mother-to-baby transmission to below 1%:

• The mother taking treatment (if she is not already doing so).
• She may be offered a Caesarean birth if her viral load is detectable.
• The baby is given a course of HIV treatment for the first few weeks.
• The mother not breastfeeding.

How could you get HIV from contact with blood?

Text

The risk of HIV transmission through blood comes when the person has a detectable viral load and their blood enters another person’s body or comes into contact with a mucous membrane. These are parts of the body with wet, absorbent skin such as the:

• eyes
• vagina
• head of the penis
• inside of the anus
• mouth.

There’s also a risk if blood from a person who has a detectable viral load comes into contact with a cut or broken skin, giving HIV a way through the skin and into someone’s bloodstream. If blood gets onto skin that isn’t broken, there is no risk.

In a medical setting, it’s possible for HIV to be transmitted by someone accidentally cutting themselves with a blade or needle they have used to treat a person living with HIV. 

This is called a needlestick injury. The risk of being infected in this way is very low. However, if someone thinks they have been exposed to HIV through a needlestick injury, post-exposure prophylaxis (PEP) may be an option.

How to be safe when coming into contact with infected blood

Text

A condom will act as a barrier against any contact with blood during sex. 

As well as sex, sharing equipment for injecting drugs (including steroids) is a way blood can get into someone’s body. This can be avoided by using fresh needles and not sharing needles, syringes and other equipment. 

If a woman has HIV, her menstrual blood also carries a risk of transmission if she has a detectable viral load. 

If you’re HIV negative and taking pre-exposure prophylaxis (PrEP) you’ll be protected against getting HIV if you come into contact with infectious blood.

What should I do if I need to clean up blood?

Text

HIV does not usually survive long outside of the body, but contact with blood (especially on broken skin) should be avoided. 

Hepatitis C can survive in dried blood at room temperature for several weeks, and hepatitis B can survive in dried blood for around a week outside the body.

To clean up blood that has been spilled, wear rubber gloves and mop up the liquid using bleach and warm water (one part bleach to 10 parts water). Use warm, soapy water to clean away blood spilled on someone’s body.

Put the waste, used gloves and bloodied clothes in a plastic bag, seal and throw away.

Can you get HIV from a blood transfusion?

Text

Receiving a blood transfusion or other products made from blood is safe in the UK as all blood products have been screened for infections such as HIV since 1985.

In countries that don’t have strict checks on the safety of their blood supply, receiving contaminated blood can pass the virus on. This can also happen in countries that don’t screen other blood products, organs or sperm.

Giving blood has never been a risk.

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Information Review

AIDS All about HIV infection

Brief historical information For the first time in the United States in the mid-70s, doctors noticed that patients with practically no immunity began to appear. They could not understand the reason for this, therefore the term AIDS appeared. After how many years the viral nature of the occurrence of immunodeficiency was proven.

For the first time in the USA in the mid-70s, doctors noticed that patients began to appear with practically no immunity. They could not understand the reason for this, therefore the term AIDS appeared. After how many years the viral nature of the occurrence of immunodeficiency was proven.

There are several versions of the origin of HIV:

• The immunodeficiency virus appeared about 100 years ago, but did not become widespread due to restrictions in the field of sex. The spread of the virus is associated with the fact that there was a sexual revolution, so the first cases appeared in the United States.
• In the beginning, the virus was in great apes, then a mutation occurred and the virus passed to humans. This explains the fact that the highest infection rates are in Africa and India.
• Created biological weapons. The secret laboratory was in the jungle. There was a leak, the locals got sick. Then the virus came to the United States, and due to permissiveness in sexual relations and sexual life in the United States, the disease spread.

Concept of HIV infection

HIV infection is a slowly progressive infectious disease caused by the human immunodeficiency virus. It is characterized mainly by damage to the immune system. As a result, the human body becomes highly susceptible to opportunistic (opportunistic) bacteria and tumors, from which it eventually dies.

The disease has a long course. Possibly longer than 10 years.

The latency period can vary from 5 to 10 years.
There is a known case when the clinic came 22 years after infection.
The average life expectancy of an infected person in Russia is 10-15 years.

AIDS (Acquired Immunodeficiency Syndrome) is not an independent disease, but one of the manifestations of the infectious process.
With HIV infection, AIDS develops in the final terminal stage.
AIDS can also occur with any other infectious disease, but unlike HIV, immunity can be restored, and with HIV, immunity is slowly but surely reduced to almost zero.

Etiology, epidemiology and pathogenesis

The causative agent of HIV infection is a virus of the subfamily of lentiviruses, a family of retroviruses. Currently, 2 types are distinguished: HIV-1 and HIV-2, which in turn are divided into subspecies and are indicated by small Latin letters.

The virus consists of a protein shell on which the receptors are located. The main receptor glycoprotein 120 (gp-120). Inside the shell is the core, consisting of 2 RNA molecules and the reverse transcriptase enzyme (reverse transcriptase).

A virus lives and reproduces only in a living cell. Unstable in the external environment. At a temperature of +70 +80 dies in 10 minutes. When boiled, it dies in 1-2 minutes. When exposed to disinfectants, it dies after 10 minutes. GI enzymes, saliva and sweat inactivate the virus.

In an infected person, the virus is found in all biological fluids, in all tissues and organs, but the highest concentration is:

• in the blood
• in cum
• in vaginal contents
• in liquor
• in bone marrow
• in breastfeeding mother’s milk

It is through these body fluids that infection occurs. In a dried drop of blood, the virus remains active for 3-7 days. In blood intended for transfusion and frozen serum, it persists for months and even years. Long stored in frozen semen (up to 6 months).

The source of infection is only a person infected with HIV or sick. Becomes contagious from the moment the virus enters the body and for life.

HIV transmission factors AIDS

• Human biological fluids.
• Medical instrument infected with a virus.
• Personal hygiene items: razors, manicure sets, toothbrushes and toothpicks, combs.

Ways of HIV transmission AIDS:

• Sexual
• Parenteral
• Vertical from an infected mother to the child through the placenta during pregnancy, during labor during passage through the birth canal, while breastfeeding.

It is possible for a mother to become infected from an infected child when caring for people who do not follow the rules of personal hygiene.

HIV pathogenesis AIDS:

The HIV virus enters the body only through damaged skin and mucous membranes.

HIV can affect many organs and systems, but the immune system suffers the most.

The main cells of the immune system are lymphocytes: B-lymphocytes are responsible for humoral immunity, that is, for antibody formation, and T-lymphocytes are responsible for cellular immunity, that is, for phagocytosis.

The virus mainly infects T-4 lymphocytes because the T-4 lymphocyte receptor is similar in structure to the virus receptor. Due to this similarity, the virus freely penetrates into T-4 lymphocytes. As a result, the virus multiplies and the lymphocytes die.
In a healthy person, the number of T-4 lymphocytes is from 800 to 1200 cells in one µl of blood. With a decrease in T-4 lymphocytes from 700 cells to 500, the immune system is weakened, and still can cope with the infection. With the number of T-4 lymphocytes from 499-200 cells, the immune system is sharply weakened, any opportunistic infection may develop at any time. With a decrease in T-4 lymphocytes of less than 200 cells, the immune system is completely blocked, a person is defenseless against any infection or tumor.

Clinical and diagnostic HIV AIDS

Clinical manifestations of HIV depend on the stage of the infectious process:

• Incubation period
• Acute phase
• Asymptomatic stage
• Generalized lymphadenopathy
• AIDS related complex
• AIDS.

The incubation period lasts from the moment the virus enters the human body until the formation of antibodies. Its duration is from 2-3 weeks to 1 year, on average 2-3 months.

The acute phase occurs in half of those infected with HIV. This is the primary response to the formation of antibodies. The main symptom is lymphadenopathy. Weakness, night sweats, prolonged subfebrile condition. There may also be various rashes on the mucous membrane and skin, resembling infectious mononucleosis or rubella. There may be arthralgia, myalgia. Could be oral candidiasis.
The acute phase lasts from several weeks to 2-3 months, sometimes longer. It depends on the state of the immune system. When immunity is restored, the acute phase stops.

Asymptomatic stage. The person feels well and does not consider himself sick. The only symptom may be swollen lymph nodes if they were enlarged in the acute phase. If the lymph nodes were not enlarged in the acute phase, then they will certainly increase at the end of the asymptomatic stage.
This stage lasts for several years. Can last up to 10 years.

Generalized lymphadenopathy – characterized by an increase in two or more lymph nodes, in two or more different groups. In adults, sizes are from 1-1.5 cm or more, in children 0.5 cm or more.

Lymph nodes are painless, elastic, not soldered to each other and surrounding tissues. They can either increase or decrease, this is due to the activity of the virus. Lymph nodes can atrophy in the last terminal stage of HIV. This period lasts from several years to 5.

AIDS-related complex – the number of T-4 lymphocytes 499-200 cells in 1 µl of blood. It is possible at any time the emergence and development of secondary infections caused by conditionally pathogenic flora. Fungal and herpetic lesions of the skin and mucous membranes. Unexplained fever for more than 1 month. Unexplained diarrhea for more than 1 month, with a loss of body weight of more than 10%. Pustular lesions of the skin. Repeated pharyngitis, otitis, sinusitis, which at first respond well to treatment with conventional methods, but gradually become protracted and persistent. There may be focal pulmonary tuberculosis, localized Kaposi’s sarcoma.
Without treatment, the period lasts 12-18 months. With treatment, life can be extended by several years.

AIDS is the final terminal stage. Secondary diseases are characteristic, from which patients die. These are the so-called AIDS marker diseases. They occur when T-4 lymphocytes decrease to less than 200 cells in 1 µl of blood. Without treatment, this period lasts from several months to 1 year. With timely started and effective treatment, the patient can live up to 3-5 years.

HIV diagnostics AIDS

To confirm the diagnosis, the following tests are performed:

• Enzyme-linked immunosorbent assay (ELISA)
• Immune blocking (IB)
• Polymerase chain reaction (PCR)

A mass screening method is the detection of antibodies to HIV using ELISA. False-positive reactions are common among drug addicts, tuberculosis patients and pregnant women.

Prevention of HIV AIDS

The basic principle is sanitary and educational work. All medical workers are required to carry out sanitary and educational work. Promotion of safe sex, less dangerous sex, correct use of condoms, talks about the dangers of drug addiction, talks on the prevention of HIV infection and other sexually transmitted infections with all population groups, and especially with young people.

An important aspect of prevention is the identification of HIV-infected and sick people.

Donors, certain categories of medical workers, pregnant women going for a planned operation are subject to mandatory HIV testing.

Prevention of nosocomial infection:

• Mandatory examination of blood and organ donors on the day of donation and after 6 months.
• Reduction of invasive and parenteral interventions. Carry out only under strict indications.
• Processing reusable medical instruments in accordance with current orders and instructions.

Protection – condom. Currently, this is the only way to protect against infection during sexual contact. With the correct use of these contraceptives, protection is 97%. Many doctors argue that the HIV virus can penetrate through the pores of the latex in a condom, and therefore there is a risk of infection.

HIV test. From the moment of infection to the appearance of antibodies, it takes from two to six weeks, and sometimes three months. During this period, the HIV test may give a negative result, so it is recommended to repeat it after three months.

DETAILS

The first cases of the mysterious disease were recorded in the USA, Sweden, and third world countries in the late 70s. In the Soviet Union, the first case of HIV infection was registered in 1985; until the end of the 90s, the infection in the USSR and Russia developed slowly, but in the early 2000s, the virus deeply affected the environment of drug addicts and the incidence jumped sharply. In the Russian Federation, from 60 to 80 thousand people fell ill every year. In recent years, the situation has remained alarming; the growth rate of HIV infection has not decreased. Every day, 200-300 new cases of HIV infection are registered, and every year 11,000 HIV-infected women in Russia give birth to children. Currently, 6.5 thousand HIV-infected children are registered, 40% of which are orphans.

etiology, modes of transmission, detection |

HIV infection is a disease caused by the human immunodeficiency virus (HIV), a chronic disease characterized by a specific damage to the immune system, leading to its slow destruction up to the formation of acquired immunodeficiency syndrome (AIDS), leading to rapid death of an infected with HIV. The rapid spread of HIV among the young population leads to an increase in mortality, a reduction in the birth rate, a decrease in life expectancy of the population, a reduction in the working population, an increase in healthcare costs, and causes a multifactorial destructive impact on the social and economic life of society.

Etiology

The causative agent of HIV infection, the human immunodeficiency virus (HIV), belongs to the lentivirus subfamily of the retrovirus family. There are two types of virus: HIV-1 and HIV-2. HIV-1 is the most common pathogen with pandemic potential, while HIV-2 occurs predominantly in West Africa. HIV-1 and HIV-2 were once acquired by humans from two different species of monkeys, but modern cases of human infection from monkeys have not been recorded. Infected people are considered the only source of HIV. If biological safety requirements are not observed in laboratory conditions, HIV infection is possible. Cases of spontaneous sanitation from the pathogen are not documented. Transmission of the virus from a person is possible at any stage of the disease, including during the incubation period.

Mechanism, factors, ways of HIV transmission

HIV infection can be transmitted through both natural and artificial transmission mechanisms.

The natural mechanisms of HIV transmission include:

– Contact, which occurs mainly through sexual contact (both homo- and heterosexual) and through contact of the mucous or wound surface with blood.

– Vertical (infection of a child from an HIV-infected mother: during pregnancy, childbirth and breastfeeding).

The artificial mechanism of transmission includes:

– Artifical during non-medical invasive procedures, including intravenous drug administration (use of syringes, needles, other injection equipment and materials), tattooing , during cosmetic, manicure and pedicure procedures non-sterile toolkit .

— Artifical for invasive interventions in the MO. HIV infection can occur through transfusion of blood, its components, transplantation of organs and tissues, use of donor sperm, donor breast milk from an HIV-infected donor, as well as through medical instruments for parenteral interventions, medical devices contaminated with HIV and not processed in accordance with with the requirements of regulatory documents.

The main factors of pathogen transmission are human biological fluids (blood, blood components, semen, vaginal discharge, breast milk).

Transmission of HIV through sexual contact. HIV is transmitted primarily through vaginal and anal sex. HIV transmission factors are: semen (in this case, HIV is not in spermatozoa, but in seminal fluid and cells), secretions of the female genital tract. The probability of HIV transmission determines a high level of viral load at the source of infection, which is observed in the early stage of the disease (incubation period, the period of primary clinical manifestation), decreases during the period of latent infection and tends to increase in the late stages of the disease.

Vertical transmission of HIV. The child of an HIV-infected woman can acquire HIV during pregnancy and childbirth, and in the postpartum period through breastfeeding. Transmission factors are blood, pathological discharge and breast milk.

There have been registered cases of HIV transmission from an infected child to a breastfeeding woman in the presence of erosions in the oral cavity of a child who was in the phase of acute HIV – infection and the presence of cracks in the areola in the mother.

Transmission of HIV through transfusion of blood components and organ and tissue transplantation is due to the direct entry of infected material into an uninfected organism. Virtually all tissues and organs of an HIV-infected donor can be a factor in HIV transmission.

Transmission of HIV by artificial insemination is similar to sexual transmission of HIV. Transmission factors are sperm and other donor materials.

HIV transmission through medically invasive procedures is possible when using instruments contaminated with the HIV virus that have not undergone regulated disinfection and sterilization treatment.

HIV transmission through non-medical parenteral interventions: in users of psychotropic substances through intravenous administration (use of shared blood-contaminated needles and syringes by several drug users, exposure of blood of an HIV-infected person to drug solutions, in the liquid used to wash syringes, on other items used when preparing and using a drug solution).

A similar route of transmission can be observed with parenteral administration of anabolics, acupuncture, tattooing, piercing, etc. Isolated cases of HIV transmission have been recorded when the blood of an HIV-infected person comes into contact with damaged skin and mucous membranes of an uninfected person, for example, when providing first aid and treating a wound surface without using gloves or other barriers.

Susceptibility to HIV. Particularly vulnerable groups of the population.

The susceptibility of the population to the HIV virus is high.

Potentially the entire population is more or less vulnerable to HIV infection.

Users of non-medical drugs.

Men who have sex with men.

Persons in prisons may be infected with HIV prior to admission to the penitentiary system (most often as a result of drug use), as well as as a result of heterosexual or homosexual contacts.

KSR – data on HIV testing results of this main vulnerable population group is not recorded in the forms of federal statistical observation.

Patients with STI are a representative group, the detection of HIV infection in which reflects the general patterns of development of the epidemic process of HIV infection in the general population of the population as a whole.

HIV clinic.

Within a few months after infection with HIV, there may be a short period of acute events resembling acute respiratory infections, rubella or mononucleosis, and then HIV infection for many years proceeds latently without visible manifestations. At this time, HIV infection can only be detected by conducting a special diagnostic laboratory test of blood or other materials for markers of HIV infection. In subsequent years, HIV gradually depletes the human immune system: in 50% within 8-10 years and in 95% within 20 years after infection with HIV develops AIDS, which is expressed in the development of life-threatening opportunistic diseases, usually caused by microorganisms that are not dangerous for healthy people, or tumors etiologically associated with viruses. If untreated, an AIDS patient dies within 1 year. The median life expectancy of a person after HIV infection in the absence of treatment is 10-12 years, individual HIV-infected individuals live more than 20 years, which determines the long duration of possible transmission of the pathogen. The long absence of clinical manifestations and the long existence of potential sources leads to the imperceptible spread of HIV among the population of different countries and territories, and years later – the massive development of AIDS in HIV-infected people and their death in the absence of treatment.

Detection (laboratory diagnosis) of HIV infection.

Diagnosis of HIV infection in the Russian Federation is carried out on the basis of an integrated approach based on epidemiological, clinical and laboratory data.

Laboratory diagnosis of HIV infection is based on the detection of antibodies to HIV and viral antigens, as well as, in special cases, the detection of HIV proviral DNA and HIV viral RNA (in children of the first year of life and persons in the incubation period). Until a positive immune blot test or detection of HIV RNA or DNA is obtained, persons with positive results from other tests, as well as those with questionable immune blot results, are considered suspect for infection with HIV infection, and it is recommended that they be subjected to epidemic control measures, such as suspension from donation, counseling, for pregnant women – planning to start chemoprevention of mother-to-child transmission of HIV.

A negative HIV antibody test result does not always mean that a person is not infected because there is a “seronegative window” (the time between HIV infection and the appearance of antibodies), which is usually about 3 months; during this period, HIV infection may confirm the detection of HIV antigens or HIV gene material. In some cases, with insufficient laboratory confirmation data, it is possible to assume the presence of HIV infection based on epidemiological data (for example, if there is a history of transfusion of blood components from an HIV-infected donor, children born to HIV-infected mothers) and / or clinical manifestations of HIV infection.

In such cases, the organization and implementation of anti-epidemic measures is carried out without waiting for laboratory confirmation, because due to the high viral load in the absence of antibodies in the early stage of the disease, HIV-infected people are the most dangerous sources of HIV infection.

Simple/rapid HIV specific antibody tests (tests that can be performed without special equipment in less than 60 minutes) are used in Russia for timely decision-making, but are not the main method for diagnosing HIV infection. It is advisable to use them for testing various hard-to-reach population groups, including when carrying out preventive measures and actions. Blood, serum, blood plasma and saliva (scraping from the gum mucosa) can be used as the test material.

When HIV infection is detected by simple/rapid tests, it is necessary to inform the patient about preliminary test results and refer him/her as soon as possible to an infectious disease specialist of an authorized specialized medical organization that carries out organizational and methodological work on diagnostic, therapeutic, preventive and anti-epidemic measures for HIV -infections (AIDS Center) for clinical examination, history taking, diagnosis of HIV infection and timely initiation of treatment. If HIV infection is detected among representatives of vulnerable groups of the population, it is advisable to additionally provide them with accompaniment to the above-mentioned specialized medical organizations. Accompaniment can be carried out, including with the help of employees or volunteers of non-governmental organizations in accordance with the approved procedure for interaction between organizations. In case of a negative result of the survey, simple / quick as part of preventive measures and actions, the study by the classical ELISA method is not mandatory, but can be carried out at the request of the subject or when risk factors for HIV infection are identified.

The issuance of a conclusion on the presence or absence of HIV infection only on the results of a simple / rapid test is not allowed.

Laboratory tests for the diagnosis of HIV infection are carried out in institutions of the state, municipal or private healthcare system on the basis of a sanitary and epidemiological report and a license issued in accordance with the procedure established by the legislation of the Russian Federation.