An HIV antibody test at 13 weeks is conclusive, regardless of the route of exposure.  If you had a negative result, you are home free.  No, I have never had a patient negative at either 2 months or 3 months and positive later.

Good luck--  HHH, MD

Do severe seasonal allergies cause immune disfunction?... could this cause a false neg. response with oraquik testing?

Yep, your're right, pretty hypocritical of me to write that when I notice, looking at some older posts, that I have done the same thing. I realize that my comment was too critical. I read what you and others contribute here, and it is almost always supportive and good stuff. Not sure where I was coming from based on what I wrote, but I wish I could take it back. I think I was just frustrated, and I wrongly took it out on others. So, my apologies.

As for me offering medical opinion, I am going to try not to do that in the future. Thank you for pointing that out to me. It may be best that I not offer any opinion at all. It's just that I see others in the same situation as I, and I want to help. I don't know, have to think about this one.

In any event, I just want to say one final thing: this site has been an invaluable resource for me. And, not just because of the doc, but also because of people like you Brian, who take the time to lend a supportive word and your knowledge. I appreciate it, more thank you probably know ;-). Be well and take care of yourself.

Perhaps we should be careful about offering medical advice. Perhaps we should not do so at all. Perhaps we should be wary of becoming like so many other sites out there, where "lay" people offer up their opinions on this topic. And then scare the **** out of the normal users who are anxious and afraid.

Personally, unless I can reassure someone, I won't offer my opinion on anything. The people who come here pay to see the Doc, not me.

Just a thought.

"Perhaps we should be careful about offering medical advice. Perhaps we should not do so at all. Perhaps we should be wary of becoming like so many other sites out there, where "lay" people offer up their opinions on this topic. And then scare the **** out of the normal users who are anxious and afraid"

Personally, unless I can reassure someone, I won't offer my opinion on anything. The people who come here pay to see the Doc, not me.

Just a thought.



In regards to your comment:

I too have never posted nor reflected on person(s) situations that I do not feel comfortable reflecting on if I am unaware of the predicament they have explained.

Nontheless, there is the "disclosure" bar that states quite clearly that the "opinion(s) reflected by the comments section are not to be taken for sound medical advice"  This bar is located just below the MD's advice to the proposed forum presenter.

However, and I do not want to seem tacky here, but you yourself have contributed some medical info. to contributing participants as well in the past.

Brian

I kind of said that in jest. I know how long HIV remains infectious outside the body is much more complicated than the window period. I agree with what Dr. H says on this forum. I actually think he does a little cya of his own, in that he really feels that closer to 99% of people will convert by 6 weeks.

Hey folks,

Just to clarify, my PCP recalled around a half dozen cases of late seroconversion, remembering perhaps two with the newer tests. He did tell me, however, that in all these cases, the people who tested positive had "flashing red lights" around them. They'd had sex with hundreds of partners with no protection, or they'd been sharing needles for 20 years, or they'd been with an HIV+ partner in a long-term relationship.

To clarify what he told me after my HIV scare last year, he said that after three months, I no longer needed to use protection with my wife and I could live my life as if I didn't have the virus. So it wasn't as if he pasted an orange warning sign on my chest and told me to live in fear for 6 months. On the contrary, he told me to relax and put my worries behind me...

BUT he insisted that I get tested at 6 months. He told me it was more like participating in ongoing research. He fundamentally trusts the 3-month window, but his trust isn't 100% so he won't take any chances on missing an infection.

I don't know what more to say to people who have such heightened stress about this testing window. All I can say is I lived for a long time with HIV risk constantly hovering over me, since I am bisexual and became active with both sexes in the late 1980s when a lot was not known. You just have to learn to live with these mental nuances. Getting an HIV test is not the same thing as thinking it's likely you have HIV. You could feasibly be screened for testicular cancer at the age of 25 and not assume for any reason that you have it; you're just going for a routine checkup. Think of it that way, and relax.

J

Johnny V

My PCP in New York has years of experience with HIV and still uses the 6 month window, largely because he _has_ seen people, even with the most recent tests, who tested positive in the 4-5 month range, even without health aberrations.




Now its comments like THAT, that make it IMPOSSBLE for WW to accept the 13 week test.  If anyone is concerned about testing ect.  you should go on aidmeds.com  Its a GREAT site with EXPERTS who are HIV+;  these experts have been working closing and following stats CLOSELY!!  They only support the most up to date info on that site.  This site seems to VARY wayyyyy toooo much with the Dr.s thoughts.  A 13 week test is as GOOD AS GOLD!!!!!  Its safe to move on with your life.  The ONLY way it might not be conclusive is if you have had other unprotected acts since, or if you are on CHEMO, heavily into drugs; or you immune system is SEVERLY DAMAGED.  If any of that stuff was the case then you wont be sitting here typing away, or reading forums right now.  13 WEEKS= CONCLUSIVE!!!!  No if ands or butts about it!!!!!!!!!!!!

My apology for having caused so much dissention from my one thread.

Brian

In general I agree with JohnnyV's comments.  But to clarify (again) my stance on timing of HIV testing, suffers from too much nuance; it breaks a cardinal rule of health education, the KISS principle:  "Keep it simple, stupid".  So although I sigh with frustration at having to repeat my views so often, I understand the reasons for misunderstanding.

I AGREE WITH 3 MONTHS AS THE TIME FOR DEFINITIVE RESULTS OF THE STANDARD EIA (ELISA) ANTIBODY TESTS AND I ALWAYS HAVE.  However, the reliability of a given test result depends on the prior probability of infection, not only the time interval.  Almost all questions on this topic describe very low risk exposures (say 1 chance in a million, often even lower).  With a negative test that has 90% reliability, those odds drop to 1 in 10 million.  Any common sense analysis says that is low enough to be considered 100% reassurance against infection.  Testing at 6 weeks (and maybe 4 weeks, especially with Duo EIA/P24 testing)meets that 90% standard.

I always tell questioners that if this level of reassurance isn't enough, i.e. they remain nervous despite such low odds, they should also get tested at 3 months.

To whoever asked about diabetes, it does not affect the reliability of HIV testing.  And although the conditions cited by brian123 (JRA and others) might affect the test results, it's only theory, not proved fact; if they have that effect, it is rare.  And of course the conditions themselves are rare as well.

HHH, MD

It's too bad there are so many conflicting indicators out there about the testing window!

Just to add my two cents, since I did very extensive research on this last summer and the year following.

--Dr Handfield's view of the testing window is one of the shortest, citing 6 weeks as a reliable window barring any aggravated risks. That view is shared by massachusetts, I believe. But it is not a common view; very few experts will endorse it.

--The 12 week/13 week difference is confusing but mostly deals with finding a number of days that people can easily count. Most calendar months are not 28 days, so 3 months in the calendar sense is 13 weeks, but 3 months in the sense of one month equaling four weeks, makes for 12 weeks.

--The vast majority of medical opinions seem to agree on the 12-13 week range, including the states with the heaviest HIV case loads like New York and California.

--Nonetheless, the 6-month testing window is not such an outlandish professional opinion as it may appear in some of the discussion above. Lots of leading research centers, like Harvard University's health website, still say 6 months is the window. My PCP in New York has years of experience with HIV and still uses the 6 month window, largely because he _has_ seen people, even with the most recent tests, who tested positive in the 4-5 month range, even without health aberrations. The cases are extremely rare -- for instance, in a clinic that probably administers thousands of HIV tests every year, my doctor has seen a handful of cases over a period of 17 years.

--The difficulty with the testing window seems to be anecdotal versus documented evidence. There are many HIV cases with transmission circumstances that can't be confirmed or are kept confidential, thereby never making it into the CDC's registry and never becoming part of the official statistics. Sometimes when people claim to have been infected with HIV from one harmless incident of oral sex, for example, the doctors doubt the truthfulness of the person, so his data is excluded from the data set. Similarly with the testing window, people who claim they haven't had any sex in the last 6 months and suddenly test positive sometimes have stories that don't add up. The result is that you have mixed signals from the CDC and other researchers -- based on what they've seen, they wish they could give a more hopeful picture, but based on what they know might have been excluded from the data, they show restraint and play it conservative.

--Having gone through a big HIV scare in 2005, and having gotten tested 16 times in my life so far, I know how stressful these things can be. But I think it's important to differentiate getting an HIV test from thinking that you have have HIV. It's important to have the peace of mind to know your chances are extremely slim that you have HIV if you test negative at 6 weeks, BUT still go and get tested at 3 months and 6 months. If for no other reason, going to get tested at 3 months and 6 months helps the HIV medical field track information better and it will help confirm with greater certainty what the testing window actually is.

J

"My PCP in New York has years of experience with HIV and still uses the 6 month window, largely because he _has_ seen people, even with the most recent tests, who tested positive in the 4-5 month range, even without health aberrations."

I don't believe it.  Not that I distrust JohnnyV's provider's honesty, just that research in provider behavior and recall show that retrospective recollections of that sort are often unreliable.  Providers tend to greatly overestimate the frequency of atypical events and patients.  The data from controlled studies are very much more reliable than any single health care provider's memory.  And the research on time to seroconversion are pretty good.

But Camass certainly is right, that regardless of how valid the data, statements like that--and testimonials on various websites--are an important reason for skepticism about my perspective by frightened, anxious persons.

HHH, MD

The window period is about as clear to me as how long HIV "survives" outside the body.

Even in some otherwise healthy individuals, doesn

I've never heard of diabetes affecting HIV testing accuracy, so I'm positive it doesn't have an effect. Considering that over 20 million people have diabetes in this country, I guarantee you that if it did affect testing accuracy, you'd hear about it all over the place.

yup - this is was my reasoning too - funny that I am just trying to believe in my fabulous result at 3 months and then I see something like this on the net and it freaks me out completely! thanks monkeyflower!

Please let me know

I would kindly ask Dr HHH to comment on what has been posted by Brian123 regarding diabetes.

I have a mildly elevated fasting glucose level (technically diabetic but just above the norm and not talking any drugs). i have tested at 13.6 weeks and was thrilled that i can put the HIV story behind me and now I am reading (I should stop reading the internet) that diabetes may affect the conclusiveness of my results. This is the first time I hear about it - my doctor said my glucose level problem i irrelevant for HIV testing. up to 2% of population is affected by diabetes and probably the second half does not know about - is it possible that this can invalidate the modern HIV tests? hard to believe.

Dr HHH, I beg you, could you please comment on this issue. I am very worried now! Brian123, where do you have this information from?

Your vaccination will NOT interfere with your test results.

If you don't mind my asking, what was the precipitating event? You're probably way overtesting...

You had misinterpreted my information for starters.

It is believed that someone who has just been recently diagnosed with diabetes I/II and does not have their diabetes under control and/or has had problems with diabetes that is "out of control" could have caused problems in seroconversion delay.

I think you are obsessing just a tad too much.
Stop reading so much negative info. on the Internet...it only will help perpetuate a fear that is non-existant to begin with in the first place.

Brian

You're spitting hairs.  You can't find information on 12 vs 13 weeks because such data don't exist.  Thirteen weeks is quoted because it's equivalent to 3 months.  But some people consider 12 weeks the same as three months.   Nobody ever will know whether there is a measurable differnece between test reliability at 12 vs 13 weeks, because it isn't important enough for anybody to research it.

HHH, MD

Thank you Dr. Hunter.

I went to the CDC

12 weeks is conisdered "conclusive" in New York State and I believe all of Canada.

Brian

One more question, is it 12 or 13 weeks that is considered conclusive?

A risk is a risk...as far as I am concerned. Whether it be sexual or needle stick injury.
I think it comes from the liability of the medical field/medical facility to have the person who was exposed to a needle stick injury to test @ 6 months...since they more than likely stick to the "old standard" for legal reasons.

Testing @ 13 weeks would be conclusive considered you do not have: Junior Rheumatoid Arthritis, onset of diabetes, Lupus, blood transfusion, or any other medical condition that has impacted your immune system recently.

A test for a "normal" (and I use that term loosely) individual would have known their positive result @ 6- 8 weeks.

I believe health care workers still "stick" to the old CDC standard since 1985, which is 6 months.  Any "normal" human being would know by 6 weeks as far as I am concerned.

I remember several years ago being tested (and this was in 1998), the woman who had tested me said: "Put it this way, if you were infected with the flu (a virus) , would it really take 3 months to create antibodies to it?"  Answer: No.
I thought this was a great analogy....or isn't it?

Brian