Reactive results

Published: 30 June 2012
  • Rapid test results may be described as being either ‘negative’ or ‘reactive’.
  • A reactive (‘positive’) result is only preliminary and must be followed up with confirmatory tests.

In the case of rapid tests, it is common for test results to be described as being either ‘negative’ or ‘reactive’.

While an HIV-negative result can be confidently given with one rapid test result alone, what appears to be a positive result could be a false positive and could cause unnecessary distress if incorrectly given. As with any other HIV test, the reactive (‘positive’) result needs to be confirmed with confirmatory tests before an HIV-positive diagnosis can be made.

A particular challenge with rapid tests is how to communicate a reactive result to the client (who may be present while the result is being read) and explain that supplementary tests are needed.

Moreover, for further testing to take place, the client must consent to have an additional sample taken. Testing is voluntary and some individuals may choose not to have further tests done, especially when this involves providing a venous blood sample or going to a different healthcare facility. More individuals may agree to confirmatory testing and receive their results if the test used is another rapid test, from a different manufacturer.1,2

These problems are less frequently faced with traditional laboratory-based testing – a large enough blood sample is taken to allow for it to be tested several times and for any uncertainties in the diagnosis to be resolved. The person taking the test is rarely aware that all of this is going on.

The United States Centers for Disease Control and Prevention (CDC) say that it is essential for health care providers to:

  • Explain the meaning of the reactive test result in simple terms, avoiding technical jargon.
  • Emphasize the importance of confirmatory testing and schedule a return visit for the confirmatory test results.
  • Underscore the importance of taking precautions to avoid the possibility of transmitting infection to others while awaiting results of confirmatory testing.

They suggest that a simple message to convey this information could be “Your preliminary test result is positive, but we won’t know for sure if you are infected with HIV until we get the results from your confirmatory test. In the meantime, you should take precautions to avoid transmitting the virus.”3

Other providers may wish to avoid the use of the word ‘positive’ altogether and stick to the term ‘reactive’. While its meaning may not be immediately clear, it can be explained in terms of the test reacting to something in the person's blood.

References

  1. Scott VF et al. The Howard University Hospital experience with routineized HIV screening: a progress report. Trans Am Clin Climatol Assoc 120:429-34, 2009
  2. Martin E et al. Use of a rapid HIV testing algorithm to improve linkage to care. Journal of Clinical Virology, S11-S15, 2011
  3. US Centers for Disease Control and Prevention (CDC) HIV counseling with rapid tests. http://www.cdc.gov/hiv/topics/testing/resources/factsheets/rt_counseling.htm, 2007
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.