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Follow-up after exposure
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Follow-up after exposure

Hi Dr,

I wrote the following post last week:

http://www.medhelp.org/posts/HIV---International/Im-panicing/show/1852792#post_8587046

•I had sex with a CSW in Thailand on December 1st at 1.00am
•After I ejaculated, I realized that the condom was broken

I follow Dr Jose advice and went to have a HIV PCR Test on December 10th at 11am, so exactly 9 days and 10 hours after the exposure. The results of the test are:

Specimen: EDTA Plasma
HIV PCR: Negative by Nested PCR

The doctor told me that:

•HIV Risk  from a single unprotected sex is 0.3%
•The HIV PCR can have false positive and false negative, so need to do a DUO at 28 days and antibody at 3 months

I have the following questions:

1.The doctor told me the test was PCR RNA but it doesn’t mention any “RNA” in my results. What do you think?
2.Dr Jose told me to do the test 10 days after exposure. I did it 9 days and 10 hours after exposure. Do you think it is an issue?
3.I’m confused with the HIV PCR accuracy. The doctor told me that it is not a conclusive test and the methodology/process of this test can differ from one country to another, so that’s why we need to get the DUO at 28 days and antibody at 3 months. But I see in some your post that you have very high accuracy of PCR after 7 days. Honestly, I’m mixed and don’t know how to interpret this negative PCR result. Some says it is good. Some not. Have you ever heard of false negative PCR?
4.The doctor told me that even after the DUO, I need an antibody after 3 months to have conclusive and final result. What do you think?
5.Do you think this doctor is very conservative? I’m asking this because in most literature, I found the risk of getting HIV from a single unprotected sex is less than0.3% and he seems to be the only one to say that the DUO test after 28 days is not 100% conclusive.
6.Can I have unprotected sex with my wife now?
7.The most important question: With all the above, what is your opinion of my current situation?
1024580_tn?1331577721
Hello,
Thank you for your new post.  I will try to answer each of your questions here below:

1.The doctor told me the test was PCR RNA but it doesn’t mention any “RNA” in my results. What do you think?
WELL, I CAN'T TELL.  IF THE DOCTOR SAID THAT IT WAS AN RNA TEST, YOU HAVE TO TRUST HIM.

2.Dr Jose told me to do the test 10 days after exposure. I did it 9 days and 10 hours after exposure. Do you think it is an issue?
NO, NOT AT ALL AS THERE WOULD BE NO SIGNIFICANT STATISTICAL DIFFERENCE AND THE TEST WOULD HAVE APPROXIMATELY A RELIABILITY OF 99%.

3.I’m confused with the HIV PCR accuracy. The doctor told me that it is not a conclusive test and the methodology/process of this test can differ from one country to another, so that’s why we need to get the DUO at 28 days and antibody at 3 months. But I see in some your post that you have very high accuracy of PCR after 7 days. Honestly, I’m mixed and don’t know how to interpret this negative PCR result. Some says it is good. Some not. Have you ever heard of false negative PCR?
THESE TESTS ARE HIGHLY SENSITIVE AND VERY RELIABLE WITH A HIGH LEVEL OF ACCURACY AFTER 7-10 DAYS.  IN THE UK, WE USE THE PCR RNA TEST MULTIPLEX, ALSO USED BY THE BLOOD TRANSFUSION SERVICE.  IN PRACTICAL TERMS, IN A CASE LIKE YOURS WITH A RELATIVELY LOW RISK, WE COULD CONSIDER IT CONCLUSIVE.  HOWEVER CURRENT GUIDELINES STILL RECOMMEND A HIV DUO TEST AFTER 4 WEEKS.

4.The doctor told me that even after the DUO, I need an antibody after 3 months to have conclusive and final result. What do you think?
I DO NOT AGREE WITH THAT.  A NEGATIVE DUO AFTER 4 WEEKS IS CERTAINLY FINAL AND FULLY CONCLUSIVE WITHOUT THE NEED OF ANY FURTHER TESTS.

5.Do you think this doctor is very conservative? I’m asking this because in most literature, I found the risk of getting HIV from a single unprotected sex is less than0.3% and he seems to be the only one to say that the DUO test after 28 days is not 100% conclusive.
IT IS POSSIBLE AND THEY MIGHT HAVE DIFFERENT GUIDELINES THERE.  THE ESTIMATED RISK OF HIV FOR THE MAN THROUGH UNPROTECTED VAGINAL PENETRATION WITH A HIV POSITIVE WOMAN IS ABOUT 0.1% (1 IN 1,000)

6.Can I have unprotected sex with my wife now?
YOU NEED TO BE TESTED FOR ALL OTHER STDs, INCLUDING CHLAMYDIA, GONORRHOEA, HEPATITIS B AND SYPHILIS.
7.The most important question: With all the above, what is your opinion of my current situation? .
TO BE ON THE SAFE SIDE, I WOULD ADVICE YOU TO GET A FULL STD SCREENING AS ABOVE AT 4 WEEKS, INCLUDING A HIV DUO TEST.  AT THIS WINDOW PERIOD, ALL TESTS WILL BE CONCLUSIVE.

Best wishes,
Dr José
10 Comments
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Avatar_m_tn
Forgot to say: I'm still worried
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Avatar_m_tn
One additional question. I got the PCR results in less than 24hrs.

Is it possible to have such quick TAT? I'm in Thailand and it seems that even in the west, it takes much longer than that to have PCR results

Thanks for you kind support.
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Avatar_m_tn
Thanks Dr Jose for your response!

I heard that the PCR accuracy depends a lot on the quality of the lab and the technician performing the test. That worries me a little bit as I have no idea of the quality of the lab/technician here in Thailand and I'm not sure they used the MULTIPLEX you are referring to. What's your opinion?

Also, considering the test and the encounter, how do you assess my HIV risk? I'm still worried a lot

Thanks
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Avatar_m_tn
FYI, the hospital confirmed the Test method is RT Nested PCR RNA.
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1024580_tn?1331577721
That is a good test.
If we combine a negative PCR RNA test combined with a sexual encounter of vaginal penetration, with a condom breaking and unkown atatus of the other person, we can conclude that it is highly unlikely that you have been infected.  I am confident that you are ok.
Best wishes,
Dr José
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Avatar_m_tn
Thanks!

The Hospital sent me an additionnal email saying that the PCR test was only for HIV-1. Any issue you think?
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Avatar_m_tn
Hi Dr. Jose,

Thanks for all the information you gave me so far.

I'm worried that the skills of the lab who performed the PCR test is not as good as your in London, so the level of accurcy of the result are not good.

When I read your post, I was quite confident that I was ok, but now knowing that I did the test in Thailand without knowing if the technology used is the state-of-art, I starting again to question my infection risk. What can I do? What question I can ask the hospital to assess the quality of their test? Does the name of the test I gave you specify the technology used? Is it similar to the one you use?

Sorry to bother you so much. You and an other dr from the HIV-Prevention forum are my only support in the high period of stress. Thanks so much

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Avatar_m_tn
Hi Dr Jose,

In addition to my last post, I have an additional question: I know good practice says to have DUO test at 28 days. If I get it 3 weeks post exposure, is there a lot of chance to have a result different from the one at 28 days? Thanks for your help!

Regards
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Avatar_m_tn
Please help me
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