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Currently, there are around 150,000 HIV-infected patients in Spain. This number, together with the fact that this disease is now a chronic condition since the introduction of antiretroviral therapy, has generated an increasing demand on the clinical microbiology laboratories in our hospitals. This increase has occurred not only in the diagnosis and treatment of opportunistic diseases, but also in tests related to the diagnosis and therapeutic management of HIV infection. To meet this demand, the Sociedad de Enfermedades Infecciosas y Microbiología Clinica (Spanish Society of Infectious Diseases and Clinical Microbiology) has updated its standard Procedure for the microbiological diagnosis of HIV infection. The main advances related to serological diagnosis, plasma viral load, and detection of resistance to antiretroviral drugs are reviewed in this version of the Procedure.

Quality assurance of HIV testing is essential to correctly assess the HIV epidemic. To describe the characteristics of HIV testing and identify features that could be improved, a questionnaire on the quality of HIV tests was sent to Catalan laboratories in 1998. The survey revealed variability in the procedures used by the participating laboratories when performing HIV tests. Some of the laboratories were still performing incorrect activities such as identifying HIV specimens with specific labels, extracting new specimens for a second test to confirm diagnosis, or failing to guarantee the confidentiality of the results. The criteria for HIV testing should be standardized according to the purpose of the test and the prevalence of the infection in the population analyzed. This approach would improve the quality of the results of diagnostic tests, since the overall concept of quality includes the entire process (pre-test, test and post-test).