What Is the ELISA/Western Blot Test?

A series of blood screenings are performed to test for HIV. The enzyme-linked
immunosorbent assay (ELISA), also known as an enzyme immunoassay (EIA), is the
first test that your healthcare provider will order to screen for HIV. ELISA, like the
Western blot test, detects HIV antibodies in your blood. Antibodies are proteins your
immune system produces in response to the presence of foreign substances, such as
viruses. If you test positive for HIV on the ELISA test, your provider will order
the Western blot test to confirm HIV infection.

When Is this Test Recommended?

The ELISA and Western blot tests are recommended if you have been exposed to HIV
or are at risk for contracting HIV. Those at risk for HIV include:

intravenous (IV) drug users

people who have unprotected sex, especially with someone who has HIV or has
an unknown HIV status
people who have had sexually transmitted diseases (STDs)
people who had blood transfusions or blood clotting factor injections before 1985
You may opt to have the test done if you are uncertain about your HIV status, even if
you are not in a high-risk group. It is a good idea to be tested on a regular basis if you
participate in high-risk behaviors, such as IV drug use or unprotected sex.

An ELISA test may be used to diagnose:

HIV, which causes AIDS
Lyme disease
pernicious anemia
Rocky Mountain spotted fever (RMSF)
rotavirus
squamous cell carcinoma
syphilis
toxoplasmosis
varicella-zoster virus, which causes chicken pox and shingles
ELISA is often used as a screening tool before more in-depth tests are ordered. A
doctor may suggest this test if youre having signs or symptoms of the conditions above
or your doctor wants to rule out any of these conditions.

What Happens During the Test?

Before having these tests, you will probably need to sign a consent form. The test and
procedure should be explained to you. The procedure for getting a sample of your blood
is the same for both tests. A medical professional will:

clean your inner arm with a solution to decrease the number of bacteria or germs
on the skin surface overlying the vein that they intend to access for the blood
sample
apply a tourniquet, or elastic band, around your arm to make the veins swell with
blood
place a needle into one of your veins and draw a small sample of blood into a
tube
remove the needle and apply a bandage
You may be asked to elevate or flex your arm to reduce the blood flow after the test, to
decrease further bleeding.
Giving a blood sample is not painful, though you may feel a sting or a pricking sensation
as the needle goes into your vein. Your arm may throb slightly after the procedure.

The blood sample will be sent to a laboratory for analysis. For the ELISA test, a lab
technician adds the sample to a petri dish containing HIV antigen. An antigen is any
foreign substance, such as a virus, that causes your immune system to respond.

If your blood contains antibodies to HIV, it will bind with the antigen. The technician will
check this by adding an enzyme (a protein that helps speed up chemical reactions) to
the petri dish and watching how your blood and the antigen react. If the contents of the
dish change color, you may have HIV.

The general process of a Western blot test is similar. However, the Western blot method
is more complicated. It involves separating the HIV sample into its component proteins
using an electrical current. Then, these proteins are transferred to a special kind of
paper (blotting) and reacted with your blood sample. An enzyme is used to cause color
change and detect antibodies.

What Do the Test Results Mean?

If you test positive for HIV on the ELISA test, you might have HIV. However, sometimes
there can be false positives with the ELISA screen. This means that test results indicate
that you have HIV when you actually do not. Further testing is required to confirm
whether you have the disease. For example, having certain disease such as Lyme
disease, syphilis, or lupus may produce a false positive for HIV in an ELISA test.

If you test positive on the ELISA screen, your healthcare provider will order a Western
blot test. If you test positive for HIV with the Western blot test, you probably have HIV.

Sometimes, HIV does not show up on the ELISA test even though you are infected.
This can happen if someone is in the early stages of the infection, and his or her body
has not produced enough antibodies (in response to the virus) for the tests to detect.
This early stage of the disease, in which a person has HIV but tests negative for it, is
known as the window period.

According to the Centers for Disease Control and Prevention (CDC), a persons window
period is usually between two and eight weeks, and the average is 25 days. However, in
rare cases, some people can take as long as six months to develop antibodies.