Informed Consent HIV Blood Test

1. I wish to do the blood test for detection of antibodies to the Human Immunodeficiency Virus (HIV). I understand that this test is a screening test and may not be conclusive. I am aware that a positive result means additional tests or samples may be needed for confirmation, and a negative result does not necessarily eliminate the infection with HIV.
2. I have also been informed that the results of this blood test will only be released to the referring physician with my consent or to me.
3. Please mention any history & result of HIV 1&2 Abs test done any time before.
4. I understand that all Positive/Reactive results should be repeated or confirmed with a fresh sample and/or a more sensitive method.

Important information on the HIV antibody test (Please read):

1. This blood test checks for the presence of antibodies to the Human Immunodeficiency Virus (HIV) which causes AIDS.
2. A positive/reactive result could mean you have been exposed to the virus, but more testing would be needed for confirmation. A true positive result does not mean you have AIDS, but it could develop in the future. It also means you could pass the virus on to others and therefore should not have unprotected sex or share injection needles with anyone.
3. A negative/non-reactive result means that no antibodies to HIV were detected in your blood. This result could mean you have never been exposed to the virus, but you also could have been infected in the very recent past (Window Period) and it is too soon for antibodies to be produced yet. A negative result does not mean that you are immune to HIV, and therefore you still need to follow all precautions regarding exposure to blood and body fluids through unprotected sex, dirty needles, etc.
4. HIV testing is especially important in pregnancy. If a pregnant woman is HIV positive, she has up to a 30% chance of infecting her unborn baby before or during birth, or afterwards through breastfeeding. However, if she takes antiviral drugs during pregnancy, her baby has only an 8 % chance of becoming infected. Most experts strongly recommend HIV testing in pregnancy.
5. False Reactive HIV Results have been described in the following cases: Pregnancy, Hemodialysis patients, poly-transfused patients (HLA DR4 sensitivity), in patients with cellular immune defects, Positive Plasmodia Abs, Leukocyte Antibodies, Mycobacterial Disease (Pulmonary TB, Leprosy), Sepsis, Steven-Johnson Syndrome, Patients with Lupus (Positive WB possible), Multiple sclerosis, Lymphoma, After administration of Immunoglobulin vaccinations (eg. Hepatitis, Influenza).