HIV Testing
In practice, there are three ways to identify human immunodeficiency virus (HIV):
Nucleic acid identification, i.e., its RNA
Antigen detection, i.e., the p24 antigen
Antibody detection, i.e., anti–HIV-1 and –HIV-2 antibodies
Kementerian Kesehatan Republik Indonesia (Kemenkes RI) recommends two assays: rapid tests and enzyme immunoassays. The serum-based 4th-generation HIV test can detect the p24 antigen and both HIV antibodies, and is available on either assay, the former of which is more widely available. However, users of Peridot will probably have access to the latter, which in early stages of HIV infection has higher sensitivity (i.e., lower rate of giving a false positive result). It is also important to note that these tests might not detect HIV during the 3-week window period of HIV exposure, as some assays are not reliable within this acute period.
There are algorithms healthcare providers follow to diagnose HIV. The Centers for Disease Control and Prevention (CDC) recommends starting out with an antigen-antibody immunoassay that can detect either antibody against HIV, as well as the p24 antigen. If a reactive result is given, testing is followed up with an immunoassay that has the ability to differentiate the HIV-1 and -2 antibodies. If the differentiation immunoassay returns a reactive result for any of the two antibodies, the patient is considered HIV-positive. However, if both are non-reactive, the patient needs to follow up with an HIV-1 nucleic acid test to confirm an acute HIV-1 infection.
Kemenkes RI uses a different algorithm with three different assays. The criteria state that the first assay needs to have an over 99% sensitivity, the second assay needs to have an over 98% specificity (i.e., the rate of not giving a false negative result), and the third assay needs to have an over 99% specificity. If the first assay is reactive, the patient needs to go through with the second assay. If the second assay is non-reactive, the patient needs to do a retest with the first assay to confirm whether or not it was a false positive result or not. However, if the second assay is indeed reactive, the patient should test with the third assay, after which they will be presented with a positive or inconclusive result based on the third assay's reactivity.
Infants have a high risk of HIV infection if their mother is infected. However, infants below 18 months are recommended to do virology testing, as serology testing might detect maternal IgG antibodies transferred through the placenta. Kemenkes RI nevertheless prepares a serology testing algorithm in accompaniment with presumptive anamnesis- and symptom-based diagnostic criteria for areas in Indonesia without access to virology testing.
HIV is a silent yet debilitating disease that eats at your adaptive immune system. In over 50% of cases in Indonesia, HIV is only diagnosed after it reaches the acquired immunodeficiency syndrome (AIDS) stage. In a majority of cases, AIDS only happens around a decade after infection, by which point your immune system can no longer fight off infections, leaving you prone to opportunistic infections. If you are between the ages of 13 and 64, you should receive HIV testing at least once. If you are of a high-risk population (among which are sex workers, people who inject drugs, transgender people, and men who have sex with men), it is especially recommended that you receive HIV testing every year. Early diagnosis is of utmost importance, so that you can immediately start antiretroviral therapy to prevent the disease from progressing to later stages.
References
Justiz AA, Gulick PG, Swinkels HM. HIV and AIDS Syndrome [Internet]. Nih.gov. StatPearls Publishing; 2024 [cited 2026 May 1]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534860.
Huynh K, Kahwaji CI. HIV Testing [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2021 [cited 2026 May 1]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482145.
Menteri Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 23 Tahun 2022 tentang Penanggulangan Human Immunodeficiency Virus, Acquired Immunodeficiency Syndrome, dan Infeksi Menular Seksual [Internet]. 2022 [cited 2026 May 1]. Available from: https://peraturan.bpk.go.id/Details/245543/permenkes-no-23-tahun-2022.
Centers for Disease Control and Prevention. 2018 Quick Reference Guide: Recommended Laboratory HIV Testing Algorithm for Serum or Plasma Specimens [Internet]. stacks.cdc.gov. 2018 [cited 2026 May 1]. Available from: https://stacks.cdc.gov/view/cdc/50872.
Riono P, Challacombe SJ. HIV in Indonesia and in neighbouring countries and its social impact. Oral Diseases [Internet]. 2020 Aug 30 [cited 2026 May 1];26(S1):28–33. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/odi.13560.
