Tuesday, July 16, 2013

7.15.13

            Today was my first day in the laboratory where they do test for HIV, Hep B, C, syphilis, CD4+ (the muy importante immune cells that HIV attacks), and viral load (how much HIV do you have inside you?).
            Nathalie told me to wear bata blanca all white scrubs in the lab. So on Monday I got there at 8:15ish and the two nurses I recognized from getting results previously for counseling. They were seated in a little room next to the room where they do their test. I walked in and introduced myself as Nina and asked if Nathalie had given them a heads up that I would be spending sometimes with them in the laboratory. They introduced themselves a Sol y Guadalupe. They were eating breakfast and so I sat down while they finished that and gossiped about some family dispute.
            Finally at 845ish they meandered into the room where they draw blood. They explained the process: patient goes to counseling, gets registered, comes to lab, they take a tube of blood and run a bunch of tests, give the results back to counseling, and counseling gives the patient the results. They take the paper from counseling, have the patient say their name and present identification to make sure everything matches up with the computer. They then put it on a piece of paper and again into the computer. Then they take the tube, print a label, label the tube. Then they show the patient that their name is on the tube and check it with the ID. Then finally they take the blood. From the tube of blood they take out a drop and put in on a fast HIV test.
            The fast HIV test is a type of immunoassay – similar to a sandwhich elisa that looks for anti-HIV antibodies.  It only takes 15 minutes to do, but this test does have the limitation that one must have had the virus for over a month and a half in order to have amassed the sufficient amount of antibodies.
            Antibodies are one of the ways that your body fights invaders They mark the invader as bad news bears so that other cells can come eat them and they cover the bad guys so that they can’t attack to stuff (like your CD4+ cells). Every person has a gazillion antibodies already in their system to almost every foreign body you could imagine. This is so that a person can begin to respond to an infection the moment it enters your body. But, it takes a while for your body to make enough of the particular splinter-fighting antibody, or chicken-pox-fighting antibody, or in our case HIV-fighting antibody to be detectible. This means that you have to have had HIV for at least a month and a half to have anti-HIV antibodies in your system. So if you got HIV yesterday and take the HIV test today you’ll come out negative even though you’re infected with the virus.
            Once they do the fast assay they send the tube of blood for Hep B, C, and syphilis on every patient that comes through the doors. If the fast test comes out negative, they also send that blood for and antigen test. This looks for the virus itself and thus can detect HIV more rapidly than the antibody test. For example if you got HIV 2 weeks ago, you won’t have high enough levels of HIV fighters (antibodies) but you will have a bunch of HIV in you. This helps to close the possibility of someone getting a negative result and still actually having the virus. If the rapid test was positive, then we take two more tubes of blood and measure the number of CD4+ cells (immune cells that protect you that HIV attacks and demolishes) and your viral load (how much HIV do you have?). This way they can tell that same day how badly you have HIV.

            The women here are curt but efficient. They work very well together and do the blood test, get old results for counseling, and do the rapid HIV test. They are making and effort to learn my name and one of them gave me an info sheet on the test that they use. I think it comes with each box, but it explains the mechanism of the rapid test pretty well... 

MORE TO COME :) check back tomorrow!

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