HIV Testing: How Accurate Are At-Home and Rapid Tests?

If you believe you may have HIV (human immunodeficiency virus), a range of tests are easily available and highly accurate in detecting the virus that causes AIDS.

HIV is a type of virus that attacks the immune system, interfering with the body’s ability to fight off infection or disease. Sometimes, HIV leads to acquired immunodeficiency syndrome, or AIDS.

Approximately 1.1 million people have HIV in the United States, and it is one of the world’s most pressing public health issues. In 2019, it was reported that approximately 37.9 million people worldwide were living with HIV at the end of 2018.

One of the main obstacles doctors face in reducing the rate of HIV infection is a lack of awareness and access to testing. The Centers for Disease Control and Prevention (CDC) estimates that, in 2018, nearly 38,000 people in the United States and six of its territories were diagnosed with HIV. The agency says that about 40 percent of new infections are transmitted by people who are unaware that they have HIV.

As a result, the CDC is attempting to make testing more widely available outside the standard medical settings.

What are the benefits of HIV testing?

The only way to know if you have HIV is to get tested. There are many potential benefits of having an HIV test, according to UCSF Health:

• If the HIV test results are positive, your doctor can begin devising a treatment plan that will help prevent infections and complications and help you live a healthy life for years to come.
• If you have HIV but don’t treat it, the health consequences could be severe, or even fatal.
• An early HIV diagnosis will alert you to behaviors that could spread the virus to sex partners and others.
• Getting the test done can provide peace of mind if you think you may have been exposed to the virus.

Do you need an HIV test?

In a word, yes. Everyone does. The CDC recommends that everyone 13 to 64 years old undergo HIV testing at least one time.

People with specific risk factors should be tested more often, including:

• Men who have been sexually active with other men
• People who have engaged in vaginal or anal sex with a partner who is HIV positive
• People who have had more than one sex partner since their last HIV test
• People who have shared needles used for tattoos or body piercings
• People who have injected drugs or have shared needles or other drug-use items, such as water or cotton, with others
• Those who have accepted drugs or money in exchange for offering sex
• People who have been diagnosed with other sexually transmitted diseases (STDs)
• Those who have been diagnosed with or treated for hepatitis or tuberculosis
• People who have had sex with a person who has at least one of the above risk factors
• People who have had sex with someone with an unknown sexual history
• People who have been sexually assaulted; the test should be taken as soon after the assault as possible

Types of HIV tests

There are several types of HIV tests, according to UW Medicine, including the following:

• HIV antibody tests: These tests look for an HIV antibody that the immune system produces, not the virus itself. Antibodies are produced only once the immune system has reacted to the HIV infection. As a result, they cannot be detected right away. In general, the “window period” for antibody tests — the period of time between when someone becomes infected with HIV and the point at which the virus can be detected — is about a month. However, for some people the window period is longer.
• Rapid HIV tests: There are a number of different “rapid” tests for HIV. These are antibody-only tests. Most of these tests are conducted in a doctor’s office or clinic, with results available in about a half-hour (though some test results are ready as quickly as one minute later). Some rapid HIV tests rely on saliva, while others use a blood sample. The appeal of having a rapid test is that you don’t have to wait around for the results.
• Home HIV tests: The only HIV antibody test that is FDA-approved for home use is the OraQuick home HIV test. This test, which looks for antibodies in your saliva, has a longer window period than some other tests. It is available at pharmacies for about $50.
• HIV antigen/antibody tests: This newer type of HIV test is able to detect HIV sooner than the antibody-only tests. It looks for HIV antibodies, and it can also detect a small part of the virus itself that's called the antigen. This is important because the HIV antigen may be in the blood sooner than HIV antibodies. Thus, the window period for this type of test is shorter (two to three weeks after infection) than that of antibody-only tests.
• Nucleic acid tests (NATs): This test looks for HIV in the blood. Nucleic acid tests are very expensive and are usually used only to screen people in specific circumstances, such as exposure to HIV in combination with symptoms of early HIV infection.

In-home, rapid and standard HIV tests - which is most accurate?

Although all of the HIV tests described above are very accurate, false positive results do occur. For this reason, it is very important to have a follow-up test if you receive a preliminary positive, aka “reactive,” test result. This is particularly true of rapid HIV tests, which are more prone to error than are regular lab tests. However, all preliminary positive test results require follow-up testing to make sure the initial result was accurate.

If the preliminary and follow-up test results are positive, you can be sure that you have HIV. But remember, a positive HIV test result does not mean that you will develop AIDS or that your disease is fatal. It means that you are carrying the virus that can cause AIDS. You will need to start a treatment plan to stay healthy. You will also have to take precautions to protect others.

If the results of your preliminary HIV test are negative, you probably do not have HIV. But you might be infected if you picked up the virus quite recently. Because HIV is undetectable for a certain period of time, it is still important that you speak with your doctor about follow-up testing, even if your preliminary test result is negative.

It’s all in the timing - when to get tested

If you had unprotected sex and are experiencing anxiety over the potential consequences, rest assured that this is normal. But don’t assume that you contracted HIV or another sexually transmitted disease. Instead, focus on the steps you can take to give yourself peace of mind.

Many people rush out to get tested right away. But due to the window period, patience is important when it comes to HIV testing. As a general rule, HIV tests are most accurate about a month after exposure. However, note that the window period can vary from two weeks to six months, so it is very important to get in touch with your doctor as soon as possible to find out when it’s best for you to be tested.

It’s important to remember that you may need to get tested for HIV more than once. Any time you think you may have been exposed to the virus, you should be tested again. Your doctor can help you figure out how often you should be tested.

Additional information

More information about HIV testing is available from:

AIDSinfo, a service of the U.S. Department of Health and Human Services. It offers a wealth of information on HIV treatment and prevention, clinical trials and other topics of interest to people affected by HIV/AIDS. Information is available in English and Spanish. It can be reached:

• By phone: 1-800-HIV-0440 (1-800-448-0440); 1-888-480-3739 TTY; or, from outside of the United States, 1-301-315-2816
• Online: aidsinfo.nih.gov

CDC-INFO: This is the CDC’s national contact center, where live agents are available to answer your questions by phone or email and help you locate the latest reputable information on HIV and hundreds of other health-related topics.

• Telephone hotline: 800-232-4636
• Online: https://www.cdc.gov/cdc-info/index.html