Children younger than 6 years may not even make the heterophile antibodies, so a negative test on a young child shouldn't affect clinical decision-making, Dr. Krilov said. “The antibodies are detected in up to 85% of older kids and adolescents, but [in] 40% or less of those younger than 4 years. If you have a patient of the appropriate age and the appropriate symptoms, and the test is negative, you can treat it as early disease and test again in 1–2 weeks. Or you have the option of sending to the lab for specific serology.”
Dr. Krilov also touched on the issue of in-office HIV testing. Two CLIA-waived kits are available and give results in 20 minutes. “I think it's useful in some clinical settings, since it allows more people to be tested. At present, we estimate that up to 280,000 people in the U.S. are unaware that they have an HIV infection. The bad news is they don't give a complete diagnostics, so a positive test always has to be confirmed by the Western blot analysis, and a false positive can create a lot of anxiety. The other part of HIV testing is, if you do the test, it needs to be done in conjunction with counseling and hooking patients into appropriate follow-up.”